晚期卵巢上皮癌理想减瘤中侵袭性术式的预测

Prediction of aggressive surgeries during maximal tumor cytoreduction in advanced ovarian epithelial cancer

目的探讨多学科协作以CT影像预测晚期卵巢癌理想减瘤术中具体侵袭性术式的可靠性。方法多学科协作对60例ⅢC～Ⅳ期卵巢上皮癌患者CT影像阅片分析,针对14个困难减瘤区域,进行〉1 cm病灶及相应的侵袭性手术方式的预测,与实际手术情况对照。结果横隔及肝膈面、肝门部、肝肾隐窝、肝实质、脾实质、脾周、结肠脾曲、横结肠、结肠肝曲、回盲部、直乙状结肠、肾静脉水平肿大淋巴结、前盆盆腔腹膜、小肠系膜根病灶预测准确度分别为100.0%、93.3%、81.7%、100.0%、100.0%、90.0%、85.0%、76.7%、83.3%、96.0%、88.3%、93.3%、98.3%、86.7%;侵袭性手术方式预测的灵敏度除直乙状结肠、前盆盆腔腹膜分别为80.0%、85.7%外,其余部位均达到100.0%。结论基于CT影像,针对困难减瘤区域,多学科协作预测最大限度卵巢上皮癌减瘤的侵袭性手术方式,灵敏度高,为开创新的术前评价模式提供了思路。

Objective To study the value of prediction of aggressive surgeries in maximal tumor cytoreduction based on CT images analyzed by multidisciplinary doctors in patients with advanced ovarian cancer. Methods The data of clinic and surgery were collected in 60 cases with stageⅢC～Ⅳovarian cancer. All CT scan images were analyzed by multi-displinary doctors. Prediction of tumor leisions and corresponding aggressive surgeries were recorded one by one in 14 difficulted cytoreductive re-gions including surface of diaphragm and hepatic capsule,hepatic hilum,hepatorenal recess,liver parenchyma,splenic paren-chyma,perisplenic fascia,colic splenic flexure,colic hepatic flexcure,transvers colon,ileoceacal junction,rectosigmoid colon, large or high level lymph node retroperitoneum,pelvic peritoneal and root of intestinal mesentery. Results According to surgical fingings,the accuracy of CT prediction for lesions in the 14 regions were 100. 0%,93. 3%,81. 7%,100. 0%,100. 0%, 90. 0%,85. 0%,76. 7%,83. 3%,96. 0%,88. 3%,93. 3%,98. 3% and 86. 7% respectively. According to 77 times ag-gressive surgeries in 42 cases with optimal tumor cytoreduction,the sensibility of CT prediction in former 13 regions were attained to 100. 0% apart from that in region of rectosigmoid and pelvic peritoneal were 80. 0% and 85. 7% respectively. Conclusion CT prediction for aggressive surgeries in maximal tumor cytoreductive surgery is very sensitive,which means that assessing maxi-mal surgical risk become capable and reliable. The new style of prediction seems better in meeting clincal practice in advanced o-varian cancer,and may be a new approach to assess optimal cytoreduction before surgery in future.