【摘要】 目的探讨腹腔镜在晚期上皮性卵巢癌诊治中的应用价值、适应证与禁忌证。方法选择2011年1月至2017年1月在青岛市市立医院就诊的可疑晚期上皮性卵巢癌58例行腹腔镜诊治,流程如下:(1)吸取腹水、多点活检明确诊断。(2)腹腔镜下评估分期。(3)临床决策——初始肿瘤细胞减灭术、新辅助化疗(NACT)或其他治疗。结果 58例患者均术中明确诊断及分期,其中1例诊断肝静脉淤血综合征、1例为腹腔结核,其余56例均术中确诊为晚期上皮性卵巢癌。其中26例行初始肿瘤细胞减灭术(腹腔镜下手术12例、开腹手术14例)。其余30例经腹腔镜下评估不能完成满意肿瘤细胞减灭术行NACT 3疗程后,行实体瘤疗效评估,26例完全缓解或部分缓解者者,再行腹腔镜下评估,并完成中间型肿瘤细胞减灭术(腹腔镜下手术20例,开腹手术6例);4例病情稳定或进展者改行其他治疗。56例晚期卵巢癌患者的中位无进展生存期为12个月,总生存期为31个月。结论腹腔镜在晚期上皮性卵巢癌诊断、临床分期、临床决策方面具有一定的价值,可供临床妇科肿瘤医生参考。更多还原

【Abstract】 Objective To explore the value,indications and contraindications of laparoscopy in the diagnosis and treatment of advanced epithelial ovarian cancer.Methods A total of 58 cases with suspected advanced ovarian cancer from January 2011 to January 2017 in Qingdao Municipal Hospital underwent laparoscopic surgery.The process was as follows:(1)Absorb ascites and perform multi-point biopsy to confirm diagnosis.(2) Assess clinical stage under laparoscope.(3)Make clinical decision——primary cytoreductive surgery,neoadjuvant chemotherapy(NACT),or other treatments.Results All 58 cases were confirmed diagnosis and stage.One case was diagnosed as hepatic congestion syndrome,1 case was diagnosed as celiac tuberculosis,and the other 56 cases were diagnosed as advanced epithelial ovarian cancer.Among them 26 cases underwent primary debulking surgery(PDS)(12 cases underwent laparoscopic surgery and 14 cases underwent laparotomy).The other 30 cases,who couldn’t finish optimal PDS according to laparoscopic assessment,underwent NACT and were evaluated on response of solid tumor after 3 periods of NACT;26 cases of CR or PR accepted laparoscopic surgery again and achieved interval debulking surgery(IDS)(20 cases underwent laparoscopic surgery and 6 cases underwent laparotomy);4 cases with SD or PD accepted other treatments.The median PFS of 56 cases was 12 months,and the median OS was 31 months.Conclusion Laparoscopy has some values in diagnosis,clinical staging and clinical decision of advanced epithelial ovarian cancer.It can be used as a reference for gynecologic oncologist.更多还原