晚期卵巢上皮性癌初次肿瘤细胞减灭术中行胰腺部分切除的临床观察  

Clinical observation of partial pancreatectomy as part of primary cytoreductive surgery in advanced epithelial ovarian cancer

作　　者：向礼兵[1] 涂云霞[1] 贺天聪 裴璇[1] 沈旭霞[2] 杨文涛[2] 吴小华[1] 杨慧娟[1] 

机构地区：[1] 复旦大学附属肿瘤医院妇瘤科,上海200032 [2] 复旦大学附属肿瘤医院病理科,上海200032

出　　处：《中华妇产科杂志》2016年第5期361-365,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的：探讨晚期卵巢上皮性癌（卵巢癌）初次肿瘤细胞减灭术中行胰腺部分切除的安全性和疗效。方法2009年4月至2015年7月间复旦大学附属肿瘤医院共有2500例原发性卵巢癌患者接受了初次肿瘤细胞减灭术，其中8例患者因胰腺远端受肿瘤侵犯同时接受了胰尾或胰体尾切除术。回顾性分析这8例患者的临床病理特点、肿瘤累及范围及手术范围、术后病变残留情况、术后并发症及生存情况等。结果（1）临床病理特点：8例患者的中位年龄为58岁（39～63岁），术前中位血清CA125水平为1688 kU/L（119～5000 kU/L），胰体尾处中位肿瘤直径为4.5 cm（3～10 cm）。病理类型：8例患者均为高级别卵巢浆液性腺癌；手术病理分期：Ⅲc期4例，Ⅳ期4例。（2）肿瘤累及范围及手术范围：8例患者术中探查均见肿瘤病灶广泛播散，均累及上腹部、中腹部及盆腔；8例患者均接受了子宫＋双侧附件＋大网膜＋盆腔腹膜＋部分胰腺＋脾切除术，每例患者接受了平均9.6个不同部位的盆腹腔内肿瘤切除。8例行远端胰腺切除术患者中，7例为胰尾切除，1例为胰尾＋部分胰体切除。术中中位出血量为1350 ml（300～3500 ml）；7例患者接受了输血，中位输血量为1150 ml（500～1800 ml）。（3）术后病变残留情况：8例患者均达到了满意的肿瘤细胞减灭术，其中无肉眼残留灶3例，残留灶直径〈0.5 cm 3例，残留灶直径〈1 cm 2例。（4）术后并发症：8例患者中，4例术后出现并发症，包括2例胰瘘、1例腹腔内出血、1例胰腺周围囊肿伴感染，经相关治疗后均治愈。（5）生存情况：随访截止至2015年9月20日，中位随访时间为17个月（2～46个月）。随访期内，3例死亡，分别在术后5、20和46个月死亡；5例存活，其中4例在治疗中，1例治疗后无复发，已存活29个月。结论晚期卵巢癌初次肿瘤细胞减灭术中行胰�Objective The aim of this study is to evaluate the safety and efficacy of partial pancreatectomy as part of primary cytoreductive surgery in advanced epithelial ovarian cancer （EOC）. Methods A total of 8 patients were recruited in this study who underwent partial pancreatectomy during the primary cytoreductive surgeries for advanced EOC in Fudan University Shanghai Cancer Center from April 2009 to July 2015. Their clinicopathological characteristics, diameter of metastatic tumors, the scope of cytoreductive surgeries, residual diseases after cytoreductive surgeries, postoperative complications and survival situation were retrospective analyzed. Results （1） Clinicopathological characteristics：the median age of these patients was 58 years old（range： 39-63 years old）. The median value of preoperative serum CA125 was 1 688 kU/L（range： 119-5 000 kU/L）. The median diameter of metastatic tumors involved in pancreatic body or tail was 4.5 cm （range：3-10 cm）. All the tumors from the 8 patients were confirmed to be high-grade serous carcinoma. Four patients were staged as International Federation of Gynecology and＆amp;nbsp;Obstetrics （FIGO）Ⅳ, and the other 4 patients were staged as FIGOⅢc. （2） Tumor metastases and the scope of cytoreductive surgeries：all of these 8 patients had widely disseminated ovarian cancer, with involvement of upper abdominal, middle abdominal and pelvic cavity. Each patient underwent extensive intra-abdominal cytoreductive surgeries, including hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic periton-ectomy, splenectomy, partial pancreatectomy. Each patient had cytoreductive surgeries of 9.6 different sites on average. Of all 8 patients who underwent partial pancreatectomy, 7 patients had pancreatic tails removed;the other 1 patient had pancreatic body and tail removed. The median volume of blood loss during surgery was 1 350 ml（range：300-3 500 ml）, blood transfusion was performed in 7 patients with the median volume of 1 150 ml （r

关 键 词：卵巢肿瘤 胰腺切除术 肿瘤细胞减灭术 

分 类 号：R737.31[医药卫生—肿瘤]