所有患者群体的大多数卵巢囊肿可自行消退。如果无强有力证据支持恶性肿瘤,治疗取决于自然消退的可能性。手术可使之立即消退,但每个患者群体有不同的复发风险。
绝经前:单纯性囊肿
大多数为功能性或生理性囊肿,不手术也可能消退。一项囊肿直径<6 cm 的绝经前女性研究发现,6 个月时的自行消退率为 50%,在 75 个月时接近 75%。[1]Knudsen UB, Tabor A, Mosgaard B, et al. Management of ovarian cysts. Acta Obstet Gynecol Scand. 2004;83:1012-1021.http://www.ncbi.nlm.nih.gov/pubmed/15488114?tool=bestpractice.com一项小型研究显示,复发率接近 40%。[65]Bonilla-Musoles F, Ballester MJ, Simon C, et al. Is avoidance of surgery possible in patients with perimenopausal ovarian tumors using transvaginal ultrasound and duplex color Doppler sonography? J Ultrasound Med. 1993;12:33-39.http://www.ncbi.nlm.nih.gov/pubmed/8455219?tool=bestpractice.com
绝经前:复杂性囊肿
与单纯性囊肿相比,此类囊肿很少自行消退。绝经前女性中,经过期待治疗后,自行消退率为 8.3%。[35]Alcazar JL, Castillo G. Comparison of 2-dimensional and 3-dimensional power-Doppler imaging in complex adnexal masses for the prediction of ovarian cancer. Am J Obstet Gynecol. 2005;192:807-812.http://www.ncbi.nlm.nih.gov/pubmed/15746675?tool=bestpractice.com腹腔镜手术或剖腹术后的复发率都很低。一项研究证明,腹腔镜手术后复发率为 7.6%,剖腹术后为 0%。[60]Laberge PY, Levesque S. Short-term morbidity and long-term recurrence rate of ovarian dermoid cysts treated by laparoscopy versus laparotomy. J Obstet Gynecol Can. 2006;28:789-793.http://www.ncbi.nlm.nih.gov/pubmed/17022919?tool=bestpractice.com
绝经后:单纯性囊肿
一项研究发现,69.4% 的单房性囊肿消退,6.8% 以单房性囊肿存在。[2]Modesitt SC, Pavlik EJ, Ueland FR, et al. Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter. Obstet Gynecol. 2003;102:594-599.http://www.ncbi.nlm.nih.gov/pubmed/12962948?tool=bestpractice.com因此,此类直径<10 cm 的肿瘤为恶性的风险极低 (< 0.1%)。另一项研究发现了类似结果,大约 45% 自行消退。[53]Castillo G, Alcazar JL, Jurado M. Natural history of sonographically detected simple unilocular adnexal cysts in asymptomatic postmenopausal women. Gynecol Oncol. 2004;92:965-969.http://www.ncbi.nlm.nih.gov/pubmed/14984967?tool=bestpractice.com
绝经后:复杂性囊肿
多房性实体瘤中,恶性肿瘤的发病率在 36% 至 39% 之间。[66]Glanc P, Brofman N, Salem S, et al. The prevalence of incidental simple ovarian cysts >or= 3 cm detected by transvaginal sonography in early pregnancy. J Obstet Gynecol Can. 2007;29:502-506.http://www.ncbi.nlm.nih.gov/pubmed/17568482?tool=bestpractice.com医生不应当对此类卵巢囊肿实施期待治疗;因此,自行消退率未知。
妊娠
大多数单纯性和复杂性肿块会自行消退,对妊娠没有风险。一项妊娠期卵巢囊肿研究证明,复杂性囊肿的自行消退率为 70%,单纯性囊肿接近 100%。[63]Bernhard LM, Klebba PK, Gray DL, et al. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol. 1999;93:585-589.http://www.ncbi.nlm.nih.gov/pubmed/10214838?tool=bestpractice.com卵巢恶性肿瘤的风险是每 12,000 至 47,000 例中有 1 例,扭转或破裂等并发症的风险为 1% 至 6%。[13]Fang YM, Gomes J, Lysikiewicz A, et al. Massive luteinized follicular cyst of pregnancy. Obstet Gynec. 2005;105:1218-1221.http://www.ncbi.nlm.nih.gov/pubmed/15863588?tool=bestpractice.com[14]Schmeler KM, Mayo-Smith WW, Peipert JF, et al. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol. 2005;105:1098-1103.http://www.ncbi.nlm.nih.gov/pubmed/15863550?tool=bestpractice.com[63]Bernhard LM, Klebba PK, Gray DL, et al. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol. 1999;93:585-589.http://www.ncbi.nlm.nih.gov/pubmed/10214838?tool=bestpractice.com