腹腔镜手术意外发现上皮性卵巢癌不同处理方式的预后分析

The prognostic analysis of unexpected epithelial ovarian malignant tumor by laparoscopy

目的：回顾性分析腹腔镜手术中意外发现的上皮性卵巢癌患者不同处理方式与预后的关系。方法：回顾2002年1月-2010年12月在大连市妇产医院因卵巢肿瘤行腹腔镜手术经病理证实为上皮性卵巢癌的患者27例（A组）,其中腹腔镜术中中转开腹行分期手术10例（A1组）,腹腔镜单纯附件切除或囊肿剔除手术,术后5~10天后行开腹再分期手术10例（A2组）,腹腔镜下同时完成分期手术7例（A3组）。选取同期早期上皮性卵巢癌开腹手术患者53例（B组）。收集患者的临床资料、术中和术后的治疗情况并随访预后情况。比较不同的手术方式对预后的影响。结果：腹腔镜术中意外发现卵巢非良性肿瘤的发生率为1.91%（72/3773）。A组与B组生存时间无差别（P〉0.05）。A组不同时间和不同途径行分期手术生存时间无差别（P〉0.05）。腹腔镜手术中囊肿破裂对生存时间无影响（P〉0.05）。结论：腹腔镜卵巢良性肿瘤手术中意外发现恶性肿瘤的发生率较低,可疑病灶需进行术中冰冻病理检查,及时发现卵巢恶性肿瘤,术中尽量避免肿瘤破裂,腹腔镜术中发现的上皮性卵巢癌尽早进行规范的分期手术不影响患者的预后,技术允许的条件下可以进行腹腔镜分期手术。

Objective：To assess the relationship between the treatment of unexpected epithelial ovarian malignant tumor in laparoscopy and the prognosis by retrospective analysis,and discuss the reasonable treatment method.Meth-ods：All 27 patients with epithelial ovarian malignant tumors were treated by laparoscopy at Dalian Obstetrics and Gy-necology Hospital from January 2002 to December 2010.53 cases of early stage epithelial ovarian cancer by laparoto-my were selected randomly in the same period.Results：The incidence of unexpected ovarian malignant tumor in lapa-roscopy was 1.91%.The median survival time of laparoscopy and laparotomy were no differences.The median survival time of laparoscopy groups done stage surgery in different time and different ways were no differences.The cyst burst had no effect on survival time.Conclusion：The incidence of the unexpected ovarian malignant tumors found during laparoscopy is low.It does not affect the prognosis of patients.