卵巢癌肿瘤细胞减灭术行肠切除术后并发肠瘘的临床观察  

Clinical observation of postoperative intestinal fistula in ovarian cancer cytoreductive surgery with intestinal resection

作　　者：周颖[1] 朱晨辰[3] 张天骄 申震 孙思楠 姚寒晖 朱亮[2] 何义仁 李敏[1] 吴大保 Zhou Ying;Zhu Chenchen;Zhang Tianjiao(Department of Obstetrics and Gynecology,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Sciences and Technology of China,Hefei 230001;Anhui Medical University,Hefei 230032)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)妇产科,合肥230001 [2]中国科学技术大学附属第一医院(安徽省立医院)胃肠外科,合肥230001 [3]安徽医科大学,合肥230032

出　　处：《现代妇产科进展》2020年第9期641-645,共5页Progress in Obstetrics and Gynecology

基　　金：国家自然科学基金(No:81872110,No:81272881);安徽省科技攻关课题(No:1704a0802151);国家重点研发计划(No:2018YFC1003900);安徽省器官移植创新计划(No:S20183400001)。

摘　　要：目的:评估卵巢癌肿瘤细胞减灭术中肠道手术的可行性和围手术期结果。方法:回顾分析2017年1月至2019年6月于中国科学技术大学附属第一医院妇产科行卵巢癌初次、中间型、再次肿瘤细胞减灭术并在术中行肠管切除术的患者的临床资料,并进行统计分析。结果:共纳入63例患者,包括46例原发性卵巢癌,其中6例接受新辅助化疗和中间型肿瘤细胞减灭术,17例复发性卵巢癌。62例(98.41%)患者达到满意减瘤,患者均接受术后化疗,初次化疗开始时间平均为术后(20.65±10.90)天(7~58天)。42例(66.67%)患者行肠管吻合术,其中2例患者发生吻合口瘘,且均评价为B级,经充分的腹腔冲洗及引流后治愈。体重指数、术前白蛋白、术前CA125水平、腹水量以及术中出血量不影响吻合口瘘的发生率,而手术复杂性评分高的病例,吻合口瘘的发生率升高(P=0.001)。结论:晚期卵巢癌患者在肿瘤细胞减灭术中进行肠管切除术后的吻合口瘘发生率是可以接受的。对于手术复杂性评分高的患者,术后管理更应谨慎。Objective:To evaluate the feasibility and perioperative outcome of intestinal resection in ovarian cancer cytoreductive surgery.Methods:We retrospectively analyzed the clinical datas of patients undergoing intestinal resection in primary,intermediate,and second ovarian cancer cytoreductive surgery during the period from January 2017 to June 2019 in our hospital.Results:A total of 63 patients were enrolled,including 46 patients with primary ovarian cancer,of whom 6 received neoadjuvant chemotherapy and intermediate cytoreductive surgery,and 17 patients with recurrent ovarian cancer.62 patients(98.41%)achieved optimal cytoreduction.All patients received postoperative chemotherapy,and the average time of initial chemotherapy was(20.65±10.90)days(7~58 days)after surgery.Among the 42 patients(66.67%)who underwent anastomosis,2 patients suffered anastomotic fistula,all of which were grade B,who were cured after adequate abdominal irrigation and drainage.Body mass index,preoperative albumin,preoperative CA125 level,ascites volume and intraoperative blood loss had no effort on the incidence of anastomotic fistula,while the higher surgery complexity score could predict the higher incidence of anastomotic fistula(P=0.001).Conclusions:The incidence of anastomotic fistula after intestinal resection in ovarian cancer cytoreductive surgery is acceptable.Postoperative management should be more cautious for patients with high surgical complexity score.

关 键 词：卵巢癌 肿瘤细胞减灭术 肠管切除术 吻合口瘘 

分 类 号：R737.31[医药卫生—肿瘤]