[1]倪琴,米鑫,张凤格,等.晚期卵巢癌腹腔镜肿瘤细胞减灭术的安全性和有效性分析[J].中国微创外科杂志,2017,17(12):1083-1100.
 Ni Qin,Mi Xin,Zhang Fengge,et al.Analysis on Safety and Effectiveness of Laparoscopic Cytoreductive Surgery for Advanced Ovarian Cancer[J].Chinese Journal of Minimally Invasive Surgery,2017,17(12):1083-1100.
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晚期卵巢癌腹腔镜肿瘤细胞减灭术的安全性和有效性分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年12期
页码:
1083-1100
栏目:
临床研究
出版日期:
2017-12-20

文章信息/Info

Title:
Analysis on Safety and Effectiveness of Laparoscopic Cytoreductive Surgery for Advanced Ovarian Cancer
作者:
倪琴米鑫张凤格郝婷魏莉从朱丹吕俊生①罗功唐②
北京市顺义区妇幼保健院妇科北京儿童医院顺义妇儿医院妇科,北京101300
Author(s):
Ni Qin Mi Xin Zhang Fengge et al.
Department of Gynecology,Shunyi Maternal and Children’s Hospital of Beijing Children’s Hospital, Beijing 101300, China
关键词:
腹腔镜手术晚期卵巢癌肿瘤细胞减灭术
Keywords:
Laparoscopic surgeryAdvanced ovarian cancerCytoreductive surgery
文献标志码:
A
摘要:
目的探讨腹腔镜下晚期卵巢癌肿瘤细胞减灭术的安全性和有效性。方法我院2013年1月~2016年12月手术治疗晚期卵巢癌50例,其中22例行腹腔镜肿瘤细胞减灭术(腹腔镜组),28例行开腹肿瘤细胞减灭术(开腹组),比较2组手术时间、术中出血量、淋巴结切除数目、切净率、术后排气时间、住院时间、并发症发生率和复发等情况。结果与开腹组比较,腹腔镜组术中出血量明显减少[(181.8±74.9)ml vs.(393.9±280.6)ml,t=-3.443,P=0001],术后肛门排气时间[(1.6±0.7)d vs.(3.2±0.9)d,t=-6.861,P=0.000]和术后住院时间[(11.0±3.6)d vs.(16.1±5.9)d,t=-3.562,P=0.000]均明显缩短。2组手术时间、淋巴结切除数目、切净率、并发症发生率均无统计学意义(P>0.05)。腹腔镜组1例术中髂外静脉损伤,1例乙状结肠损伤,均在镜下完成缝合。开腹组1例术中髂总静脉损伤,成功修补,1例术后下肢静脉血栓,抗凝治疗好转。50例随访4~52个月,中位随访时间23.5 月,2组复发率差异无统计学意义(P>005)。结论腹腔镜下晚期卵巢癌肿瘤细胞减灭术安全、可行,近期疗效满意,但要求病例选择得当,而且术者及团队需具备熟练的操作技术及处理手术并发症的经验。
Abstract:
ObjectiveTo explore the safety and effectiveness of laparoscopic cytoreductive surgery for advanced ovarian cancer.MethodsOutcomes of 50 patients with advanced ovarian cancer who underwent either laparoscopic cytoreductive surgery (laparoscopic surgery group, n=22) or laparotomic cytoreductive surgery (laparotomic surgery group, n=28) from January 2013 to December 2016 were retrospectively analyzed. The parameters including operation time, intraoperative blood loss, number of resected lymph nodes, complete resection rate, gastrointestinal recovery time, hospital stay, operative complications, and recurrence were compared between the two groups.ResultsThe laparoscopic surgery group had less intraoperative blood loss [(181.8±74.9) ml vs. (393.9±280.6) ml, t=-3.443, P=0.001], shorter gastrointestinal recovery time [(1.6±0.7) vs. (3.2±0.9) d, t=-6.861, P=0.000], and shorter hospital stay [(11.0±3.6) vs. (16.1±5.9) d, t=-3.562, P=0.000] as compared to the laparotomic surgery group. No significant difference was found in operation time, number of resected lymph nodes, complete resection rate, and operative complications rate between the two groups (P>0.05). There were 1 case of external iliac vein injury and 1 case of sigmoid injury in the laparoscopic surgery group, all of which were repaired during laparoscopic surgery. In the laparotomic surgery group, 1 case of common iliac vein injury was successfully repaired and 1 case of lower extremity venous thrombosis was cured by anticoagulant therapy. A total of 50 patients were followed up for 4-52 months (median, 23.5 months). There was no significant difference in the recurrent rate between the two groups (P>0.05).ConclusionLaparoscopic cytoreductive surgery for advanced ovarian cancer is safe and feasible in a short term, but the cases must be well selected and the surgeon and the team must have skilled operation techniques and treatment experience for complications.

参考文献/References:

[1]Siegel R, Ma J, Zou Z, et al. Cancer statistics,2014.CA Cancer J Clin,2014,64(1):9-29.
[2]Della Pepa C, Tonini G, Pisano C, et al. Ovarian cancer standard of care: are there real alternatives? Chin J Cancer,2015,34(1):17-27.
[3]Kemp Z, Ledermann J. Update on first-line treatment of advanced ovarian carcinoma. Int J Womens Health,2013,5(1):45-51.
[4]Bagley CM Jr,Young RC,Schein PS,et al.Ovarian carcinoma metastatic to the diaphragm-frequently undiagnosed at laparotomy: a preliminary report. Am J Obstet Gynecol,1973,116(3):397-400.
[5]熊维,曹莉莉,蒋路频,等.早期卵巢上皮性癌经腹腔镜与开腹行全面分期手术的临床对比分析.中华妇产科杂志,2017,52(2):103-109.
[6]Fagotti A, Ferrandina G, Fanfani F,et al.A laparoscopy-based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study. Ann Surg Oncol,2006,13(8):1156-1161.
[7]李萌,熊光武.晚期卵巢癌、输卵管癌及原发性腹膜癌腹腔镜肿瘤细胞减灭术的安全性及有效性研究.中国微创外科杂志,2012,12(2):98-100.
[8]陈婵娟,林云笑,陈昌南,等.替吉奥治疗卵巢癌术后化疗后生化复发患者的临床研究.中国现代药物应用,2017,11(5):87-88.
[9]刘永珠,胡庆兰,陈日利,等.腹腔镜与开腹手术治疗早期卵巢癌的比较.中国微创外科杂志,2014,14(7):597-599.
[10]Rutten MJ, van Meurs HS, van de Vrie R,et al. Laparoscopy to predict the result of primary cytoreductive surgery in patients with advanced ovarian cancer: a randomized controlled trial. J Clin Oncol,2017,35(6):613-621.
[11]Corrado G, Mancini E, Cutillo G, et al.Laparoscopic debulking surgery in the management of advanced ovarian cancer after neoadjuvant chemotherapy. Int J Gynecol Cancer, 2015,25(7):1253-1257.
[12]Magrina JF,Cetta RL,Chang YH,et al. Analysis of secondary cytoreduction for recurrent ovarian cancer by robotics, laparoscopy and laparotomy. Gynecol Oncol,2013,129(2):336-340.
[13]Nezhat FR,Finger TN,Vetere P,et al. Comparison of perioperative outcomes and complication rates between conventional versus robotic-assisted laparoscopy in the evaluation and management of early, advanced, and recurrent stage ovarian, fallopian tube, and primary peritoneal cancer. Int J Gynecol Cancer,2014,24(3):600-607.
[14]Heitz F,Ognjenovic D,Harter P,et al.Abdominal wall metastases in patients with ovarian cancer after laparoscopic surgery: incidence,risk factors,and complications. Int J Gynecol Cancer,2010,20(1):41-46.
[15]Nezhat FR,DeNoble SM,Liu CS,et al.The safety and efficacy of laparoscopic surgical staging and debulking of apparent advanced stage ovarian,fallopian tube,and primary peritoneal cancers.JSLS,2010,14(2):155-168.
[16]Zheng H, Gao YN. Primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer. Chin J Cancer Res,2012,24(4):304-309.
[17]Chereau E, Lavoue V, Ballester M, et al. External validation of a laparoscopic-based score to evaluate resectability for patients with advanced ovarian cancer undergoing interval debulking surgery. Anticancer Res,2011,31(12):4469-4474.
[18]Gómez-Hidalgo NR, Martinez-Cannon BA, Nick AM, et al.Predictors of optimal cytoreduction in patients with newly diagnosed advanced-stage epithelial ovarian cancer: time to incorporate laparoscopic assessment into the standard of care. Gynecol Oncol,2015,137(3):553-558.

备注/Memo

备注/Memo:
*通讯作者,E-mail:mixin1964@126.com①(中国医科大学北京顺义医院普外科,北京101300)②(中国医科大学北京顺义医院泌尿外科,北京101300)
更新日期/Last Update: 2018-03-21