复发性卵巢上皮性癌再次手术与化疗的临床价值

Clinical Evaluation of Secondary Cytoreductive Surgery and Chemotherapy on Palindromic Ovarian Epithelial Carcinoma

目的：探讨卵巢上皮性癌复发的高危因素与再次肿瘤细胞减灭术，联合化疗的临床价值。方法：对179例卵巢上皮癌临床资料进行回顾性分析。结果：179例中38例为复发癌，初次手术分期Ⅰ、Ⅱ期5例（13．2％）；Ⅲ、Ⅳ期33例（86．8％）,其中初次手术切净者12例，平均复发时间为18．1个月，基本切净者26例，平均复发时间11．8个月（P＜0．01），初次手术1年内化疗≥6个疗程者19例，平均复发时间13．3个月；初次术后1年内化疗＜6个疗程者，平均复发时间9．8个月（P＞0．05）。38例复发癌中，20例手术切除复发灶，术后采用联合化疗。5年生存率为26．4％，11例放弃手术单纯化疗，5年生存率7．4％（P＜0．01）,7例拒绝手术与化疗，5年生存率2．9％（P＜0．01）。结论：卵巢上皮性癌复发与初次手术彻底性及术后是否行规范的联合化疗密切相关。复发癌实施再次肿瘤细胞减灭术，术后坚持联合化疗与初次肿瘤细胞减灭术具有同等重要意义，仍可提高5年生存率。

Objective: To evaluate the clinical effect of secondary cytoreductive surgery combined with chemotherapy on palindromic ovarian epithelial carcinoma． Methods: The clinical materials of 179 cases of ovarian epithelial carcinoma were reviewed and analysed retrospectively． Results: Thirty－eight of 179 cases were palindromic ovarian epithelial carcinoma． The patients underwent first cytoreductive surgery including stage Ⅰ, Ⅱ 5 cases (13．2％), stage Ⅲ, Ⅳ 33 cases (86．8％)． The mean recurrent time of the tumor that had thoroughly removed (12 cases) was 18．1 months, and that of the tumor primarily removed (26 cases) was 11．8 months (P＜0．01)． The mean recurrent time of the patients had the first cytoreductive surgery with 6 or more cycles of chemotherapy in a year (19 cases) was 13．3 months and that of the patients had less than 6 cycles of chemotherapy was 9．8 months (P＞0．05)． Among 38 cases of palindromic ovarian epuithelial carcinoma, 20 cases received radical resection of palindromic tumor followed with combined chemotherapy had a 5－year survival rate of 26．4％, and that of the patients received only chemotherapy being 7．4％ (P＜0．01)． The 5－year survival rate of the patients refused operation and chemotherapy being 2．9％ (P＜0．01)． Conclusion: The recurrence of ovarian epitheluial cell carcinoma is closely associated with whether or not having thorough removal of tumor and postoperative chemotherapy． Secondary cytoreductive surgery of the palindromic tumor combined with chemotherapy has the same effect as the first cytoreductive surgry and it can improve the 5－year survival rate of the patient．