卵巢上皮癌首次术中残留肿瘤组织最大径超过2cm患者的治疗与预后  

The epithelial ovarian carcinoma with residual disease of more than 2 cm after cytoreductive initial surgery

作　　者：魏丽惠[1] 钱和年[1] 崔恒[1] 富琪[1] 屠铮[1] 虞幸[1] 

机构地区：[1]北京医科大学人民医院妇科肿瘤中心

出　　处：《北京医科大学学报》1999年第4期345-347,共3页Journal of Peking University(Health Sciences)

摘　　要：目的：对北京医科大学人民医院１９７０～１９９４年首次术中残留肿瘤组织最大径超过２ｃｍ的６９例卵巢上皮癌患者的治疗与预后进行回顾性分析。方法：６９例卵巢上皮癌中浆液性癌５４例、粘液性癌１０例、内膜样癌４例、透明细胞癌１例，其中Ⅱ期１例、Ⅲ期６４例、Ⅳ期４例。全部先行手术，确定组织类型、临床分期。２２例行第２次手术；７例行第３次手术。首次术后６７例进行了全身和腹腔化疗，２、３次术后对复发者又进行了全身化疗；对复发者中出现远处转移的９例患者除进行全身化疗，还进行了局部化疗，６例肺转移并出现胸水者加用了胸腔局部化疗，２例肝转移行肝动脉化疗，２例脑转移者行开颅术后全身化疗。结果：６９例中２年存活３２例（５０．７％）；５年存活１１例（２８．１％）；１０年存活３例，生存率１４．８％。６例肺转移合并胸水者，平均延长生存７个月（２～１２月）；２例肝转移者分别延长生存９及２９个月；２例脑转移者分别延长生存５、１６个月。结论：在卵巢癌首次术中应尽可能切除肿瘤组织，对残留肿瘤组织最大径超过２ｃｍ患者术后应积极化疗，对复发者应再次手术，化疗可延长患者生命。Objective: To retrospectively study the treatment and prognosis of 69 cases of ovarian carcinoma with residual disease of more than 2 cm after cytoreductive initial surgery. Methods: Among the 69 cases, 54 were serous carcinoma, 10 mucinous, 4 endometrioid, 1 clear cell carcinoma. One was found to be FIGO stage Ⅱ, 64 stage Ⅲ and 4 stage Ⅳ. The histologic classification and surgical staging were determined at the time of the initial surgery. Second cytoreduction was done for 22 cases and, 7 third surgery. Systemic and introperitoneal chemotherapy was used in 67 cases following primary surgery. Systemic chemotherapy was used on the recurrent cases following second and third operations. Local chemotherapy was added to 9 cases with distant metastasis, in which, intra thoracic chemotherapy was used for 6 cases with lung metastasis, 2 cases with intra arterial chemotherapy for hepatic metastasis, and systemic chemotherapy for one case of cerebral metastasis following cerebral operation. Results: The survival rates were 50.7%,28.1% and 14.8% for 2,5 to 10 years respectively. The 6 cases with lung metastasis got a median survival of 7 months (ranging from 2 12 months ), two cases of hepatic metastasis were 9 and 29 months, separately and two casese with cerebral metastases were 5 and 16 months. Conclusion: Tumor tissues should be removed ascompletely as possible at the time of the initial laparotomy. Those whose residual diseases were more than 2 cm, should be treated with chemotherapy actively.

关 键 词：卵巢肿瘤 外科手术 残留癌 再手术 预后 

分 类 号：R737.31[医药卫生—肿瘤]