18例妇科恶性肿瘤结肠、直肠手术临床分析  

The role of large bowel surgery for debulking gynecologic malignancies

作　　者：赵彦[1] 钱和年[1] 崔恒[1] 王杉[2] 李蔚范 顾晋[2] 

机构地区：[1]北京大学人民医院妇科肿瘤中心,100044 [2]北京大学人民医院外科 [3]北京大学肿瘤医院妇科

出　　处：《中国妇产科临床杂志》2001年第4期200-202,205,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的 探讨结肠、直肠手术在治疗卵巢上皮性癌和原发腹膜癌患者的手术指征和治疗效果。方法 对1988年6月～2001年5月在我院妇科接受开腹手术同时行结肠、直肠手术的18例妇科恶性肿瘤进行回顾性分析,其中卵巢上皮性癌16例,原发腹膜癌2例。结果 8例(44.4％)在初次手术中完成结肠、直肠手术,10例(55.6％)在处理复发性癌或者姑息性手术中进行。18例中接受结肠切除或者部分乙状结肠直肠手术,肠吻合术14例,其中3例手法吻合和11例吻合器吻合;4例接受结肠造瘘术患者中,1例于造瘘术后14个月行结肠造瘘还纳术。手术并发症为发热6例,腹泻3例,伤口延期愈合2例以及1例于术后49d因肿瘤进展和突发急性心肌梗塞死亡。17/18例切除肠管者术后病理示肿瘤侵犯至肠浆膜层7例,至浆肌层5例,至粘膜下层3例,至粘膜层2例。7例术后残留癌<2cm,10例>2cm,1例行姑息性手术未切除肠管。术后1年生存率为76％,2年为29％,3年为19％。2例术后存活已超过5年。结论 对卵巢上皮性癌或原发性腹膜癌患者实施结肠、直肠手术是为达到肿瘤细胞减灭或者为缓解肠梗阻症状。对可疑卵巢恶性肿瘤患者术前宜作肠道准备,术中尽量选择肠切除、肠吻合,减少结肠造瘘。对于某些妇科恶性肿瘤患者为提高治疗效果行部分肠管切除是值得的。Objective To assess indications for and efficiency of large bowel surgery in patients with ovarian cancer and primary peritoneal carcinoma. Methods A retrospective review was carried out on 18 patients who underwent colorectal resection and anastomosis or colostomy on the gynecologic malignancies from June 1988 to May 2001. 18 cases received the procedures including 16 cases with epithelial ovarian cancer and 2 with primary peritoneal carcinoma. Results The 18 operations comprised 8 primary surgical procedures (44.4% ) and 10 secondary for recurrence or palliation (55.6% ) . The colectomy or partial rectosigmoid colectomy followed by colorectal anastomosis were done on 14 patients with anastomosis by 3 hand - sewn technique, 11 gastrointestinal anastomosis (GIA) stapler, while 4 patients were received colostomy with one colostomy closure in 14 months after primary surgery. The complications related the procedure showed 6 febrile, 3 diarrhea, 2 delayed wounds recovery and 1 died of advanced ovarian cancer with acute myocardial infarction 49 days postoperatively. However no bowel obstruction, anasto-motic leak, stricture and fistula occurred, nor pulmonary embolism and thrombosis.As 17/18 patients having colectomy or rectosigmoid colectomy, 7 cases showed carcinoma invading to the serous coat of colon, 5 to the seromuscular kyer, 3 to the sub-mucous layer and 2 to the mucosa pathologicaly.The residual carcinoma of < 2 cm attained in 7 cases (38.9%) and > 2 cm in 10 cases (55.6% ), but only one had palliative colostomy. 1 year postoperative survival rate was 76%, 2 year 29% and 3 year 19% . There were 2 cases survived over 5 years. Conclusions Debulking of disease and relieve of bowel obstruction were the major indications for bowel surgery in patients with ovarian cancer and primary peritoneal carcinoma. Patients with possibly malignant ovarian masses should receive preoperative bowel preparation and be counseled that bowel surgery may be needed but colostomy is not frequently required. Large bowel surgery is a wor

关 键 词：细胞减灭术 结肠直肠切除术 结肠造瘘术 晚期卵巢癌 

分 类 号：R737.3[医药卫生—肿瘤]