卵巢癌再分期手术的临床意义

Restaging laparotomy of presumed early ovarian cancer

目的 探讨卵巢癌再分期手术的价值及其并发症的发生情况。方法 42例患者均为本院 1986年 1月至 1996年 1月收治的外院初次手术时未进行全面探查而诊断为Ⅰa～Ⅱa期的卵巢癌患者。其中 ,Ⅰa期 2 8例 ,Ⅰb期 1例 ,Ⅰc期 12例 ,Ⅱa期 1例 ;卵巢上皮性癌 2 6例 ,恶性生殖细胞肿瘤 9例 ,颗粒细胞肿瘤 7例。外院初次手术仅行患侧附件切除术 40例。结果 42例患者中 12例(2 8 6 % )患者经再分期手术证实期别提高 ,其中 8例 (19 0 % )实际应为Ⅲ期患者。 12例再分期手术阳性患者 (指再分期手术时发现有残存肿瘤者 )中 ,腹水或腹腔冲洗液细胞学检查有癌细胞者 3例 ,结肠旁沟转移 4例 ;大网膜转移 2例。 30例再分期手术阴性患者 (指再分期手术时没有发现残存肿瘤者 )中 ,3年和 5年生存率分别为 96 7%和 86 7% ;12例再分期手术阳性患者的 3年和 5年生存率分别为 12例中 7例和 12例中 3例。再分期手术的主要并发症是出血 (10 0 0 % ,出血量为 5 0～ 110 0ml,平均 2 80ml)和淋巴囊肿 (7 1% ) ,无围手术期死亡病例。结论 对初步诊断为早期卵巢癌的患者应进行全面的分期探查手术 ,初次手术时未进行全面的分期探查手术者应进行再分期手术。再分期手术阴性者预后好 ,易于治愈。再分期手术无严重并发症。

Objective To assess the value and complications of restaging laparotomy in women with presumed early ovarian cancer who have undergone inadequate initial staging procedures. Methods Between 1986 and 1996, 42 patients underwent restaging laparotomy in Cancer Hospital, Peking Union Medical College after receiving inadequate initial surgical procedure for presumed early ovarian cancer. Presumed stages from initial surgery include stage Ⅰa in 28 cases; Ⅰb in 1 case; Ⅰc in 12 cases; Ⅱa in 1 case. Histological distributions were as follows: epithelial cancer in 26 cases; malignant germ cell tumor in 9 cases; granulose cell tumor in 7 cases. Results Twelve patients (28.6%) had disease upstaged and eight (19.0%) had stage Ⅲ disease confirmed by restaging laparotomy. Positive findings at restaging laparotomy were mainly in omentum (16.7%) and pericolic gutters (33.3%). Peritoneal cytology was positive in 25.0 percent of patients. Three and five year survival rates for 30 patients with negative findings were 96.7% and 86.7%, respectively. Complications of restaging laparotomy included hemorrhage blood loss (50～ 1 100 ml, average 280 ml) and lymphocyst (7.1%). Conclusions Patients with presumed early ovarian cancer who had undergone inadequate staging procedures should undergo restaging laparotomy. Patients with negative findings have an excellent prognosis. Complications of restaging laparotomy were minor.