卵巢癌二次探查手术中淋巴结清扫的意义

背景与目的：盆腹腔淋巴结清扫是国际妇产联盟（FIGO）卵巢癌手术病理分期的主要内容之一,但在卵巢癌的二次探查手术中,盆腔和腹主动脉旁淋巴结清扫的价值还存在争议。本文拟分析有关资料,以对卵巢癌二次探查手术中淋巴结清扫的价值进行探讨。方法;收集中国医学科学院肿瘤医院1994年7月1日至1996年10月1日收治的15例Ⅲ期和Ⅳ期卵巢癌患者的临床资料并进行回顾性分析。结果：15例患者的组织病理类型均为卵巢浆液性乳头状囊腺癌;组织分化程度分别为：高分化2例、中分化7例、低分化6例。15例患者在初次细胞减灭术时均没有进行淋巴结清扫,“二探术”时患者的盆腔和腹主动脉旁淋巴结均为阴性。“二探术”阴性的10例患者中有4例（40％）发生肿瘤复发,复发部位为盆腔腹膜、腹腔和肝脏,盆腔和腹主动脉淋巴结均没有复发。结论：初次减灭术时淋巴结阴性的卵巢癌患者,在进行“二探术”时可不必进行淋巴结清扫。

Significance of lymphadenectomy in patients with epithelial ovarian cancer at second exploratory operation

BACKGROUND & OBJECTIVE: Lymphadenectomy in pelvic and para-aortic is one of the contents of FIGO staging operation in ovary cancer. The significance of lymphadenectomy in patients with epithelial ovarian cancer at second exploratory operation is unclear. This study was designed to assess the significance of lymphadenectomy in the patients with epithelial ovarian cancer at second exploratory operation. METHODS: Fifteen patients with stage III and IV epithelial ovarian cancer were treated in the Cancer Hospital of Peking Union Medical College between July 1994 and October 1996 were analyzed retrospectively. RESULTS: The degrees of differentiation were as follows: high degree in 2 patients, moderate in 7, low in 6, of the 15 patients, none of them performed lymphadenectomy and none of them was lymph node positive at second look operation. Four of 10 patients with negative findings at second look operation were recurrent, but there were no positive findings in pelvic and para-aortic lymph node. CONCLUSIONS: Lymphadenectomy at second look operation in patients with negative lymph node at primary surgery is unnecessary.