腹腔镜下卵巢上皮癌二次探查术的临床评价——附14例临床分析

Laparoscopic second-look exploration for ovary epithelial cancer: A clinical analysis of 14 cases

目的探讨腹腔镜下卵巢上皮癌二次探查术的可行性、可靠性及并发症。方法14例均采用全身麻醉。6例取开放式切口,8例用闭合式腹腔镜进腹。按四孔法进行手术,生理盐水冲洗盆腹腔,冲洗液送细胞学检查;探查盆腹腔,分离粘连,在盆腹腔约20处多点活检。结果14例均按照手术前计划完成二次探查手术,手术时间(61.3±16.7)m in,出血(98.7±32.1)m l。手术发现4例(28.6%)阳性,其中肉眼阳性3例(21.4%),镜检阳性1例(7.1%);其余10例(71.4%)阴性。4例“二探术”阳性的卵巢癌患者,手术发现肿瘤位于盆腔腹膜、结肠旁沟腹膜;所有病例无腹腔脏器损伤,无中转开腹,仅有1例行开放式腹腔镜者脐部切口延迟愈合。10例二探术阴性者中有1例(10.0%)发生肿瘤复发,复发时间为48个月。结论进行腹腔镜下卵巢上皮癌二次探查术是可行的,具有创伤小、恢复快、病人易于接受等优点。

Objective To investigate the feasibility, reliability, and complications of laparoscopic second-look exploration for ovary epithelial cancer. Methods The operation was performed under general anaesthesia. The 4-port laparoscopy was carried out. Physiological saline was used to wash the abdominal and pelvic cavity for cytological examination. Then the exploration of abdominal and pelvic cavity was performed, adhesions were dissected, and multiple punch biopsies （ at more than 20 sites） were conducted in the abdominal and pelvic cavity. Results All the operations were completed successfully. The operative time was 61.3 ± 16. 7 min, and the hemorrhage volume was 98.7 ± 32. 1 ml. Positive findings were encountered in 4 cases （28.6qe）, 3 of which （21.4%） were identified by the naked eye and 1 of which was identified by microscope, and negative findings, 10 cases （71.4%）. Of the 4 cases of positive findings, the tumor was located at the pelvic peritoneum or the paracolic sulci peritoneum. No abdominal organ injuries occurred, and no conversion to open surgery was needed. Delayed healing of umbilical incision happened in 1 case. Of the 10 cases of negative findings, recurrence of tumor was observed in 1 case （ 10. 0% ） at 48 months after operation. Conclusions Laparoscopic second-look exploration for ovary epithelial cancer is feasible, with advantages of minimal invasion, fast recovery, and good patient＇ s tolerance.