结肠、直肠手术在肿瘤细胞减灭术中的作用

The role of large bowel surgery in debulking surgery for gynecologic malignancies

目的 探讨结肠、直肠手术在治疗卵巢上皮性癌和原发腹膜癌患者的手术指征和治疗效果。方法 对 1988年 6月～2 0 0 1年 5月在我院妇科接受开腹手术同时行结肠、直肠手术的 18例妇科恶性肿瘤进行回顾性分析 ,其中卵巢上皮性癌 16例和原发腹膜癌 2例。结果 有 8例在初次手术中完成结肠、直肠手术 ,10例在处理复发性癌或者姑息性手术中进行。 18例中接受结肠切除或者部分乙状结肠直肠手术 ,肠吻合术 14例 ,接受结肠造瘘术 4例 ,其中 1例于结肠造瘘术后 14个月行结肠造瘘还纳术。 18例中有 17例切除肠管 ,术后病理显示肿瘤侵犯至肠浆膜层 7例 ,至浆肌层 5例 ,至粘膜下层 3例 ,至粘膜层 2例。有 7例术后残留癌 <2cm ,10例 >2cm ,1例行姑息性手术未切除肠管。术后 1年生存率为 76 % ,2年为 2 9% ,3年为 19%。有 2例术后存活已超过 5年。结论 对卵巢上皮性癌或者原发性腹膜癌患者实施结肠、直肠手术的主要目的是为达到肿瘤细胞减灭或者为缓解肠梗阻症状。选择一组合适的妇科恶性肿瘤病人术前最好肠道准备 ,术中尽量采用肠切除肠吻合术 ,减少结肠造瘘术 ,对提高治疗效果 ,延长病人寿命是有益的。

Objective To assess indications and efficiency of large bowel surgery in patients with ovarian cancer and primary peritoneal carcinoma. Methods A retrospective review was carried out on 18 patients who underwent colorectal resection and anastomosis or colostomy on the gynecologic malignancies from June 1988 to May 2001. 18 cases received the procedures included 16 cases with epithelial ovarian cancer and 2 with primary peritoneal carcinoma.Results 16 cases suffered with epithelial ovarian cancer and 2 with primary peritoneal carcinoma. 8 of them received colorectal resection during the primary operation and 10 of them received it at palliative operation or operation for recurrence. 14/18 cases received colectomy or partial rectosigmoid colectomy plus anastomosis, and 4/18 cases received colostomy. The complications were fever, diarrhea. delayed healing of wound, and 1 case died within 49 days with advanced ovarian cancer and acute myocardial infarction. Pathologic diagnosis proved that there were 17/18 cases had cancer invasion to the either 4 layers of colonic wall, the remaining case received only palliative colostomy. After operation, 7 cases still had<2 cm residual cancer, and 10 cases had>2 cm one. The l-year survival rate was 76%, 2-year was 29% and 3-year was 19%, two cases survived more than 5 years. Conclusion Debulking of disease and bowel obstruction were the major indications for bowel surgery for patients with ovarian cancer and primary peritoneal carcinoma. Patients with possible malignant ovarian masses should be given preoperative bowel preparation and be counseled that bowel surgery may be needed but colostomy is not frequently required. Large bowel surgery is a worthwhile endeavor in selected patients with gynecologic malignancy for increasing theraputic efficiency.