上皮性卵巢癌宫颈保留及阑尾切除的探讨

Retention of cervix uteri and appendectomy in the treatment of epithelial ovarian cancer

目的探讨上皮性卵巢癌宫颈保留的价值及适时切除阑尾的必要性。方法回顾性分析贵州省人民医院和遵义医学院附属医院1999～2008年上皮性卵巢癌患者145例，其国际妇产科联盟（FIGO）分期、组织学类型、病理分级以及阑尾、宫颈的转移情况。结果上皮性卵巢癌患者行子宫全切术者134例，均未发现宫颈转移。57例行阑尾切除术者阑尾转移率为28．1％；行阑尾切除术者早期患者未见阑尾转移，38例晚期患者阑尾转移率为42．1％；不同组织学类型、病理分级的卵巢癌患者，阑尾转移率之间比较，差异无统计学意义。结论上皮性卵巢癌不易转移到宫颈，对于年轻、早期患者以及晚期手术困难者，在手术治疗时可以保留宫颈；上皮性卵巢癌的阑尾转移与FIGO分期密切相关，从治疗目的和减少手术并发症的利弊权衡来看，主张早期患者可不切除阑尾，晚期患者以阑尾切除为宜。

Objective To investigate the value of retention of cervix uteri and the necessity of appendectomy in the treatment of epithelial ovarian cancer （EOC）. Methods The clinical data of 145 EOC patients were analyzed retrospectively. These patients were administered to Guizhou Provincial Peoples Hospital and the Affiliated Hospital of Zunyi Medical College from 1999 to 2008. Relationships between FIGO stage, pathological type, and pathological grade with metastases of appendix and cervix uteri were analyzed. Results There were no cervix uteri metastases in 134 patients with total abdominal hysterectomy. The rate of appendix metastases was 28.1%. There were no appendix metastases in early EOC patients. The rate of appendix metastases in advanced EOC patients was 42.1%. Differences in appendix metastases among different histological types and histological grades were not statistically significant. Conclusion EOC was not easily to metastasize to cervix uteri. It is reasonable to retain cervix uteri in young patients, patients in early stage, and those in the advanced stage with difficulties in surgery. The metastasis to appendix was in closely relation with FIGO stage. To reduce perioperative complications, the appendix may be retained in patients of early stage but removed in patients of advanced stage.