12熊光武-卵巢惡性腫瘤腹腔鏡手術(shù)

1、Laparoscopic Surgery of Ovarian Cancerxiong-Laparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian Cancer Bagley等. Am J Obstet Gynecol 1973 Amara等. Surg Laparosc Endosc 1996Laparoscopic Surgery of Ovarian Cancer 國(guó)內(nèi)報(bào)告 第一軍醫(yī)大學(xué)學(xué)報(bào) 2004 中國(guó)實(shí)用婦科與產(chǎn)科雜志 2006

2、Laparoscopic Surgery of Ovarian CancerFIGO分期分期腹腔鏡手術(shù)腹腔鏡手術(shù)IAIC全面確定分期/再分期手術(shù)探查、留取腹水/腹腔沖洗液?jiǎn)蝹?cè)附件/雙附件+全子宮切除術(shù)盆腔、腹主動(dòng)脈旁淋巴結(jié)切除/活檢術(shù)大網(wǎng)膜切除術(shù)腹膜多點(diǎn)活檢闌尾探查/切除術(shù)IIAIIC分期？ 減滅？IIIIV腹腔鏡探查術(shù)腹腔鏡卵巢惡性腫瘤細(xì)胞減滅術(shù)?腹腔鏡二探手術(shù)?Laparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian Cancer EOCFIGO stage I 早期卵巢惡性腫瘤(Early-stage Ov

3、arian Carcinoma, EOC) 腫瘤局限于一側(cè)或雙側(cè)卵巢 無(wú)局部或遠(yuǎn)處轉(zhuǎn)移證據(jù)Laparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ova

4、rian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of

5、 Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerGhezzi34824.59.896.196.1Laparoscopic Surgery of Ovarian Cancer腹腔鏡再 Cancer 1994; 73(Suppl 1): 14671471 Gynecol Oncol 2004, 94: 624-629再Laparoscopic Surgery of Ovarian Cance

6、rEOC EOC EOCLeBlanc E, et al. Curr Opin Obstet Gynecol 2006, 18(4): 407-412Laparoscopic Surgery of Ovarian CancerNezhat F, et al. Am J Obstet Gynecol. 2009; 200: 83.e183.e6.Laparoscopic Surgery of Ovarian Cancer 26例EOC 手術(shù)時(shí)間348min (255-450min) 術(shù)中出血量250ml(50-3000ml) 盆腔淋巴結(jié)24.56.3, 腹主動(dòng)脈旁淋巴結(jié)9.87.1 分期上升率2

7、3.1%(6/26) 無(wú)中轉(zhuǎn)開腹, 無(wú)術(shù)中并發(fā)癥 術(shù)后腹膜后血腫1例開腹手術(shù)手術(shù)止血 隨訪26.7個(gè)月(2-83M), 無(wú)復(fù)發(fā)生存率96.1%Ghezzi F, et al. Int J Gynecol Cancer 2009;19: S7-S13Laparoscopic Surgery of Ovarian CancerGhezzi F, et al. Int J Gynecol Cancer 2009;19: S7-S13Laparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian Cancer 腫瘤直徑7.92

8、cm2.19cm 手術(shù)時(shí)間 120min (90180) 出血量200ml (150300) 出院時(shí)間8天 隨訪時(shí)間1年 無(wú)復(fù)發(fā)、轉(zhuǎn)移馬麗華, 婁閣. 中國(guó)傷殘醫(yī)學(xué), 2008; 16(1): 9-11Laparoscopic Surgery of Ovarian Cancer參數(shù)腹腔鏡手術(shù)組開腹手術(shù)組P值例數(shù)(20052009)1925年齡41.913.750.815.10.0506.42.812.15.90.000手術(shù)時(shí)間min283.074.7266.665.50.443淋巴結(jié)數(shù)量20.86.520.713.80.976161.197.7398.0278.60.000術(shù)后并發(fā)癥3(15.

9、8%)5(20.0%)1.0001.70.82.71.00.002住院時(shí)間d13.44.913.26.60.920隨訪時(shí)間m23.311.421.212.60.589復(fù)發(fā)11腹腔鏡分期手術(shù)安全可行,術(shù)中出血少,術(shù)后恢復(fù)快,近期效果與開腹手術(shù)相當(dāng).Hao T, et al.中國(guó)微創(chuàng)外科雜志 2010Laparoscopic Surgery of Ovarian Cancer作者總例數(shù)并發(fā)癥數(shù)并發(fā)癥Childers141腔靜脈損傷1Pomel102術(shù)后腹腔內(nèi)出血1, 肺栓塞1Tozzi241乳糜腹1Spirtos847腸管損傷5,膀胱損傷1,靜脈損傷1Leblanc444血腫1, 淋巴囊腫3Xu2

10、13直腸損傷1, 膀胱損傷1, 轉(zhuǎn)移1Ghezzi152腹膜后血腫1, 淋巴水腫1Park (A)172靜脈損傷1, 輸尿管損傷1Park (B)192大血管損傷1, 術(shù)后發(fā)熱1Hao193敗血癥1, 淋巴囊腫2Nezhat 364小腸梗阻1, 淋巴囊腫3others1520合計(jì)45532(7.03%)損傷13, 淋巴回流障礙10,出血3, 感染2, 轉(zhuǎn)移1, 肺栓塞1,小腸梗阻1Laparoscopic Surgery of Ovarian Cancer時(shí)間例數(shù)分期再分期分期上升%復(fù)發(fā)復(fù)發(fā)%并發(fā)癥%2006年前1962716928(14.3)5(2.6)15(7.7)2006年后201121

11、8022(10.9)15(7.5)14(7.0)合計(jì)39714824950(12.6)20(5.0)29(7.3)復(fù)發(fā)率上升的可能原因: 再分期病例減少, 直接進(jìn)行分期病例數(shù)增多 病例選擇失當(dāng), II期以上病例數(shù)增多 減滅術(shù)分期手術(shù), 不夠細(xì)致、徹底Laparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of

12、 Ovarian CancerLaparoscopic Surgery of Ovarian CancerSjvall K, et al. Int J Gynecol Cancer. 1994; 4: 333.Vergote I, et al. Lancet. 2001;357:176182.Laparoscopic Surgery of Ovarian Cancer徐春陽(yáng), 等. 中華婦產(chǎn)科雜志, 2003; 38(12):766-767Laparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian CancerLa

13、paroscopic Surgery of Ovarian CancerMorice P, et al. Obstet Gynecol. 2004; 104: 11671170.Ramirez PT, et al. Gynecol Oncol. 2003; 91: 179189.Laparoscopic Surgery of Ovarian CancerLaparoscopic Surgery of Ovarian Cancer173例III/IV卵巢癌行腹腔鏡探查術(shù)(20min)17%(30例)發(fā)生穿刺部位轉(zhuǎn)移 8例(4.6%)為臨床診斷的 71在開腹手術(shù)時(shí)切除穿刺部位, 22例 (31%) 病理診斷陽(yáng)性穿刺部位轉(zhuǎn)移與隨后開始的化療和細(xì)胞減滅術(shù)的間隔時(shí)間長(zhǎng)短、有否腹水、腫瘤分期無(wú)相關(guān)性穿刺部位轉(zhuǎn)移在首次治療后均消失, 且未再