卵巢肿瘤·肠·肿瘤转移_____卵巢肿瘤·肠·肿瘤转移

卵巢癌肠道转移64例临床分析

http://www.100md.com 《中国普通现代外科进展》 2006年第2期

卵巢肿瘤·肠·肿瘤转移,,卵巢肿瘤·肠·肿瘤转移,1资料与方法,2结果,3讨论,参考文献

     【摘要】目的：回顾性分析卵巢癌肠道转移瘤的临床特点，评价手术切除的可行性及其与预后的关系。方法：64例肠道转移卵巢癌术前全面评估肠道受累程度。采用肿瘤细胞减灭术并行盆腔淋巴结清扫和腹主动脉旁淋巴结切除或/及活检术。肠道手术包括肿瘤剥除术或/及肠修补术、肠切除吻合术和结肠造口术。术后予以规律化疗，分析术后并发症及预后。结果：54例直肠/乙状结肠转移(84.4%)，其他部位结肠转移26例，小肠转移18例；肠浆膜层及浅肌层浸润47例，深肌层及粘膜层浸润17例；上皮性癌侵及肠粘膜者4例(7.7%)，生殖细胞肿瘤无一例侵及肠粘膜；行肿瘤剥除44例，肠切除20例；直肠乙状结肠切除+吻合14例，6例行结肠造口。达到理想细胞减灭术56例(87.5%)，其化疗后缓解率为58.9%，部分切除者8例化疗缓解率为12.5%；49例规则化疗者缓解率为65.3%，未完成充分化疗者为15.4%。术后并发症发生率26.6%，2例死于腹膜炎。结论：肠道是卵巢癌的常见转移部位，肠道的肿瘤剥除和肠切除术是达到理想肿瘤细胞减灭术的先决条件，术后规则化疗能改善卵巢癌患者预后。

    【关键词】卵巢肿瘤·肠·肿瘤转移

    Intestinal metastasis of ovarian cancer:clinical analysis of 64 cases

    ZHANG Shiqian1,ZHI Xuting2,LIU Naifu3,LIU Xianghuan4

    1Department of Gynecology and Obstetrics，2Department of General Surgery,Qilu Hos

    pital of Shandong University(Jinan 250012,China)

    3Department of Gynecological Oncology,Shandong Tumor Hospital(Jinan 250117,China)

    4Department of Gynecology and Obstetrics,Shandong Jining Second Hospital(Shan

    dong 272131,China)

    【ABSTRACT】Objective:To retrospectively analyze the clinical features of intestinal tract metastatic tumors of ovarian cancer,and estimate the feasibility of resection and its relation to prognosis.Methods:64 patients with ovarian cancer associated with intestinal tract metastasis were brought into this clinical analysis.The extent of intestinal tract involvement was evaluated preoperatively.Cytoreduction was defined as the residual lesion less than 1 cm3,at the same time pelvic and paraaortic lymphadenectomy and/or biopsy were implied.Intestinal surgery included tumor stripping surgery and /or intestinal repair,intestinal resection or colostomy.Regular chemotherapy was administrated,postoperative complications as well as prognosis were evaluated.Results:54 cases (84.8%) had rectum/sigmoid colon metastasis,metatsis in other parts of colon were 26 cases,small intestinal metastasis were 18 cases,infiltration of serosal and superficial muscular layer were 47 cases,17 cases had deep muscular layer and mucosal infiltration.Epithelial cancer which had invaded intestinal mucosa were 4 cases (7.7%) ,no invading to intestinal mucosa was detected in germnoma.All the 64 patients were recepted surgical treatment,including tumor stripping surgery in 44 cases,intestinal resection in 20 cases,sigmoidal and rectal resection in 14 cases,and colonost omy in 6 cases.The optical cytoreduction wasachieved in 56 cases (87.5%),and postchemotherpy regression rate was 58.9%,but the postchemotherpy regression rate was only 12.5% in 8 patients who got partial resection;regular chemotherapy was finished in 49 cases,and the regression rate was 65.3%,but the regression rate was only 15.4% in those who couldn’t finish regular chemotherapy.Postoperative morbidity was 26.6%,and two patients died of postoperative peritonitis.Conclusion:Intestinal tract is the common metastatic site of ovarian cancer,tumor stripping and intestinal resection are not only feasible but also prerequisite for optimal cytoreduction,postoperative regular chemotherapy can improve prognosis of ovarian cancer. ......

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