24例库肯勃瘤的诊治分析

Diagnosis and treatment of Krukenberg tumors: analysis of 24 cases.

目的探讨Krukenberg瘤的临床特点、诊断及治疗方法.方法回顾性分析我院1980～2004年收治的24例Krukenberg瘤的临床资料.结果 Krukenberg瘤好发于中年女性,多为双侧(18/24),原发灶病理类型多为低分化腺癌或粘液腺癌.临床分期多为中晚期(Ⅲ期、Ⅳ期胃癌15例,Dukes C、D期大肠癌7例,Dukes B期大肠癌1例,阑尾粘液类癌1例).恶性度高,易漏诊,预后极差,平均生存期不超过2年.结论确诊为卵巢恶性肿瘤时应首先排除转移癌的可能,发现卵巢转移肿瘤者,应常规行胃肠道检查以寻找原发灶.女性胃肠癌患者应考虑有无卵巢转移.有卵巢转移者,手术为首选治疗方式,需同时切除胃肠原发病灶、子宫及双侧附件.无卵巢转移者是否行预防性卵巢切除术应遵循个体化原则.

Objective To investigate the clinical feature, diagnosis and treatment of Krukenberg tumor. Methods Clinical and histological data of 24 cases with Krukenberg tumor from 1980 to 2004 were analyzed retrospectively. Results Krukenberg tumor occurs more often in middle -aged women and mostly bilateral （ 18/24 }. The most common pathological types of the primary carcinomas were poorly differentiated adenocarcinoma or myxedema. Most cases were in advanced clinicaZ stage, 15 cases of gastric carcinoma in stage Ⅲ and Ⅳ; 7 cases of large intestine carcinoma for Dukes C and D; 1 case of large intestine carcinoma for Dukes B; 1 case of appendiceal mucous carcinoid. Krukenberg turmor is hard to diagnose preoperatively and is highly malignant with poor prognosis, average survival time being less than 2 years. Conclusion Metastasized ovarian tumor should always be excluded when an ovarian malignant neoplasm is observed. Patients with metastatic ovarian neoplasm should be routinely examined for primary gastrointestine neoplasm. The female patients with gastrointestinal neoplasms should be checked for ovarian metastasis. Operation is the first choice to patients with ovarian metastasis, including resection of primary gastrointestinal neoplasms, hysterectomy and bilateral salpingoophorectomy . The prophylactic oophorectomy should be individualized for patients without ovarian metastasis.