腹腔镜卵巢恶性肿瘤再分期手术临床分析(附38例报道)

Clinical analysis of laparoscopic restaging surgery for ovarian malignancies(report of 38 cases)

目的分析卵巢恶性肿瘤腹腔镜再分期手术的临床特点,探讨腹腔镜在卵巢癌再分期手术的安全性及临床应用价值。方法回顾性分析北京大学第三医院妇产科2005~2016年行卵巢恶性肿瘤腹腔镜再分期手术38例患者的临床特点,并根据再分期手术后的手术-病理分期,给予辅助治疗及定期随访。结果所有患者均完成腹腔镜全面分期手术,其中16例患者行保留生育功能的全面分期手术。腹腔镜再分期手术时间114~521 min,平均244.7 min。术中出血量10~500 m L,平均114.7 m L。再分期手术中发现严重粘连8例,患者盆腹腔粘连程度与两次手术间隔时间、初次手术方式及手术范围均无显著相关性。术中平均切除盆腔淋巴结18.2个(7~33个),腹主动脉旁淋巴结4.7个(1~16个),术中及术后无严重并发症发生,无中转开腹病例。再分期术后患者分期上升率15.8%(6/38)。中位随访32月(8~79个月),2例患者复发,总生存率100%,无进展生存率94.7%。结论腹腔镜下卵巢恶性肿瘤再分期手术相对安全可行,可作为早期卵巢恶性肿瘤再分期手术的一种选择。

Objective To analyze the characteristics and clinical values of laparoscopic restaging surgery of ovarian malignancies. Methods Thirty - eight patients who underwent laparoscopic restaging surgery in Peking University Third Hospital from 2005 to 2016 were analyzed retrospectively,according to the surgical - pathological staging after the re -staging surgery, adjuvant therapy and regular follow - up were given. Results All the operations were completed successfully and among them, 16 patients underwent total staging surgery with reproductive function retained. The mean operative time was 244. 7 rain（ 114 -521 min） ,and the mean intraoperative blood loss was 114. 7 mL（ 10 -500 mL）. Dense adhesion was detected in 8 cases. No significant corrdation was found between the adhesion degree and the interval of the two procedures, the primary operation approach and the primary operation extent. About 18.2 pelvis lymph nodes （7 - 33 ） and 4.7 paraaortic lymph nodes （1 - 16 ） were excised. No intraoperative and postoperative complications occurred, no laparotomy cases. The upstaging rate was 15.8% （6/38） after re- staging surgery. The median follow-up was 32 months （8 - 79 months）. Two patients relapsed. The overall survival was 100%, and progression -free survival was 94.7%. Conclusion Laparoscopic restaging surgery is safe and feasible, and is an alternative for restaging of the early stage of ovarian malignancies.