腹腔镜手术在卵巢恶性肿瘤诊治中的应用(附12例报告)

Laparoscopic in Diagnosis and Treatment of Ovarian Malignancy:Report of 12 Cases

目的探讨腹腔镜手术在卵巢恶性肿瘤诊治中的价值。方法回顾分析2007年6月～2010年6月腹腔镜手术诊治12例卵巢恶性肿瘤的临床资料。肿瘤直径5～15 cm,其中4例直径>10 cm;双侧7例,单侧5例。根据不同肿瘤类型与分期分别行腹腔镜手术或转开腹手术、腹腔镜下抽放腹水、诊断分期、腹腔灌注化疗联合全身化疗。术后均化疗。结果术中意外发现卵巢恶性肿瘤6例,其中行腹腔镜下卵巢癌减灭术或转开腹各2例,行腹腔镜下保留生育功能手术或转开腹手术各1例。术前疑诊卵巢恶性肿瘤6例,术中冰冻及术后病理均得以证实,其中3例转开腹行卵巢癌减灭术,另3例晚期无手术条件者采用镜下抽放腹水、诊断分期、腹腔灌注化疗配合全身静脉化疗,最终实施了开腹卵巢癌减灭术。12例随访1～41个月,平均11.7月,1例术后11个月复发,1例失访,余10例无瘤生存。结论腹腔镜手术在卵巢肿瘤的诊断分期、治疗具有相当重要的作用。

Objective To discuss the clinical values of laparoscopy in diagnosis and treatment of ovarian malignancy.Methods An retrospective analysis was carried out in 12 cases of ovarian malignancy who underwent laproscopic diagnosis and treatment in our hospital from June 2007 to June 2010.The diameter of the tumors ranged from 5 to 15 cm,four of the cases have the tumor larger than 10 cm in diameter.Bilateral tumors were detected in 7 of the cases,and unilateral in the other 5.According to the type and stage of the tumors,laparoscopic surgery,conversion to open surgery,and aspiration of ascites and staging by laparoscopy,as well as abdominal activity infusion chemotherapy combined with systemic chemotherapy were performed on the patients.All the patients received chemotherapy after the operation. Results There were 6 ovarian malignancies unexpectedly found by laparoscopy,among which 4 were treated with cytoreductive surgery by laparoscopy or laparotomy,and 2 received laparoscopic surgery or laparotomy with the function of procreation remained.Six ovarian malignancies were diagnosed before operation,and then were confirmed with patho-results of frozen sections;among them 3 were transferred to laparotomy for cytoreductive surgery;the other 3,who were diagnosed with advanced ovarian malignancies,lost the chance for operation,and therefore received laparoscopic aspiration of ascites and staging,and infusion chemotherapy combined with systemic chemotherapy,and then cytoreductive surgery by laparotomy.The 12 cases were followed up for 1 to 41 months with a mean of 11.7,one of the patients showed recurrence in 11 months,one was lost,and the other 10 survived without tumor.Conclusion Laparoscopic surgery plays an important role in diagnosis and treatment of ovarian malignancy,more clinical data are needed to evaluate its efficacy.