腹腔镜卵巢交界性肿瘤再分期手术病例分析及文献回顾

Case Analysis and Literature Review of Laparoscopic Restaging Surgery of Borderline Ovarian Tumors

目的：分析卵巢交界性肿瘤行腹腔镜再分期手术的病例特点，探讨再分期手术的价值。方法我科1994年1月～2013年7月手术的卵巢交界性肿瘤129例中，行腹腔镜再分期手术6例。初次手术后诊断为Ⅰa期3例，Ⅰc期3例。6例均行腹腔镜全面分期手术。再分期手术包括全子宫切除（2例已生育者），一侧或双侧附件切除、大网膜切除、盆腔淋巴结清扫、腹主动脉旁淋巴结切除，3例同时行阑尾切除术。3例未生育者均行保留生育功能手术。结果腹腔镜再分期手术后病理阴性4例，阳性2例（1例为双侧卵巢肿瘤剔除术后双侧卵巢病灶残留，1例为初次手术后保留侧卵巢存在交界性病变）。6例淋巴结、大网膜或阑尾均为阴性。经腹腔镜再分期手术后分期及诊断未变5例，1例手术分期由Ⅰa期上升到Ⅰb期。无严重术中和术后并发症发生。随访10～32个月，（23．2±9．2）月，均无复发。结论腹腔镜卵巢交界性肿瘤再分期手术相对安全，也具有一定的意义。但对于初次手术肿瘤外观局限于卵巢的患者，再分期手术时盆腔和腹主动脉旁淋巴结清扫以及大网膜切除甚至阑尾切除的意义有待商榷。

Objective To evaluate the significance of laparoscopic restaging surgery for women with borderline ovarian tumors （BOT）. Methods From January 1994 to July 2013, 129 patients were treated for BOT in our department, 6 of which underwent laparoscopic restaging surgery.Three patients were diagnosed as stage Ⅰa and three as stage Ⅰc after the primary surgery.The restaging surgery was performed via the laparoscopic approach in all the 6 patients. The restaging procedures included total hysterectomy, unilateral or bilateral salpingo-oophorectomy, omentectomy, pelvic lymphadenectomy, and para-aortic lymphadenectomy.A simultaneous appendectomy was conducted in 3 patients.Fertility-sparing surgery was employed in 3 childless patients. Results Among these 6 patients, 33.3% （ 2/6 ） pathological positive cases were found after the restaging surgery, including one case with bilateral persistent BOT lesions who had initially undergone bilateral cystectomy and another case with occult small BOT lesion in the preserved ovary after the primary surgery.No matastasis was found in all the specimens of omentum, lymph nodes and appendixes.One case was up-staged fromⅠa toⅠb after restaged.There were no serious intraoperative and postoperative complications.No recurrence occurred during the follow-up for 10-32 （23.2 ±9.2） months. Conclusions The results confirm the feasibility and significance of laparoscopic restaging surgery for women with borderline ovarian tumors.However, in those patients with lesions limited in the ovary in primary surgery, the implementation of lymphadenectomy, omentectomy, as well as appendectomy in the restaging surgery should be further discussed.