原发性腹膜癌18例临床诊治分析

Clinical analysis on 18 cases of primary peritoneal carcinoma

目的探讨原发性腹膜癌（PPC）的临床诊治特点及预后情况。方法收集2004年1月至2015年12月我院诊治的18例PPC患者的临床资料,回顾性分析患者的临床表现、病理检查、肿瘤标记物、治疗方式及预后情况。结果 18例确诊PPC患者均为女性,平均年龄为（64±5）岁,其中12例（66.6%）临床表现为腹胀、腹水,17例（94.4%）术前妇科检查未见附件包块,17例（94.4%）术前CA125明显升高。16例（88.8%）术中探查仅发现大网膜或腹膜病变,15例行肿瘤细胞减灭术,其余3例行大网膜和双侧附件切除术;术后病理示：腹膜或大网膜病变倾向第二苗勒氏管来源,低分化浆液性腺癌为主,仅2例伴卵巢微小浸润。18例PPC患者的中位生存时间为30.0个月（95%CI：19.5~56.5个月）,1、2、3、5年生存率分别为87.1%、65.7%、42.6%和21.3%。结论女性PPC与晚期卵巢癌的临床病理特征相近,治疗以肿瘤细胞减灭术联合化疗为主。

Objective To investigate the clinical characteristics and prognosis of primary peritoneal carcinoma（ PPC）.Methods The clinical characteristics of 18 patients with PPC,who were treated in our hospital from January 2004 to December 2015,were analyzed retrospectively. Results Eighteen patients were women and the average age of morbidity was（ 64 ± 5） years. There were 12 cases（ 66. 6%） of abdominal distension and ascites,17 cases（ 94. 4%） without adnexal mass in gynecological examination and 17 cases（ 94. 4%） with elevated CA125. There were 16 cases（ 88. 8%） with peritoneum and / or greater omentum lesions in operation. Fifteen patients with PPC underwent cytoreductive operation,and 3 patients only underwent greater omentum and bilateral adnexectomy. Pathological examination results showed that peritoneum and / or greater omentum lesions were commonly diagnosed as poorly differentiated serous adenocarcinoma arising from mullerian duct. Ovarian microinvasion only occurred in 2 cases. By Kaplan-Meier method,the median survival time of 18 patients was 30. 0 months（ 95% CI： 19. 5-56. 5）,and the 1-,2-,3-,5-year survival rates of PPC were 87. 1%,65. 7%,42. 6% and 21. 3%. Conclusion PPC,taking surgical resection and chemotherapy as main treatment,was easy to get confused with ovarian cancer before operation.