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目的探讨腹腔镜在早期卵巢恶性肿瘤再分期手术中的临床应用价值。方法回顾性分析16例腹腔镜下早期卵巢恶性肿瘤再分期手术患者的临床资料,初次手术后诊断Ia期13例,Ic期3例,手术包括腹腔镜下全子宫切除术、保留附件切除术、骨盆漏斗韧带高位结扎术、大网膜切除术、盆腔及腹主动脉旁淋巴结清扫术和(或)阑尾切除术。结果 16例患者均在腹腔镜下顺利完成再分期手术,无术中及术后并发症发生,术中出血量(86.5±30.6)ml,手术时间(160.6±36.9)min,盆腔淋巴结切除数量(19.5±4.6)个、腹主动脉旁淋巴结切除数量(6.5±2.6)个,术后分期1例由Ia期上升至Ib期,2例由Ia期上升至Ic期,1例由Ic期上升至IIIc期,对分期为Ib期以上的或有高危因素的常规PT方案化疗3~6个疗程,随访过程无复发及穿刺孔转移。结论腹腔镜下早期卵巢恶性肿瘤再分期手术是安全可行的,有利于准确确定分期、指导术后辅助化疗,符合目前肿瘤治疗兼顾微创和根治性的趋势。
Objective To investigate the clinical value of laparoscopy in the early stage of ovarian cancer recurrence. Methods The clinical data of 16 patients undergoing laparoscopic early stage ovarian cancer recurrence were retrospectively analyzed. Thirteen cases were diagnosed after Ia, three cases were treated with Ic. The operations included laparoscopic total hysterectomy, adjuvant resection, High ligation of pelvis funnel ligament, omental resection, pelvic and para-aortic lymph node dissection and / or appendectomy. Results All the 16 patients underwent laparoscopic reoperation successfully. There were no intraoperative and postoperative complications. The blood loss (86.5 ± 30.6) ml, operation time (160.6 ± 36.9) min, number of pelvic lymph node resection 19.5 ± 4.6). The number of para-aortic lymph node dissection was (6.5 ± 2.6). One patient had stage Ia to Ib stage, two had stage Ia to Ic stage, one had Ic stage up to IIIc. The conventional PT regimen with the stage of stage Ib or higher risk is treated with 3 to 6 courses of chemotherapy. No recurrence and puncture metastasis were observed during follow-up. Conclusions Laparoscopic surgery of early malignant ovarian tumor is safe and feasible, which is helpful to accurately determine the stage and guide the postoperative adjuvant chemotherapy. It is in line with the current trend of minimally invasive and radical treatment of tumor.