女性原发性腹膜癌27例临床及病理分析

目的：探讨原发性腹膜癌（PPC）的临床特点、诊断标准、治疗方法和预后。方法：对1993年1月－2000年12月在本院治疗的27例PPC患者的临床资料进行回顾性分析，其结果均经病理检查证实。结果：27例中，浆液性乳头状腺癌21例，粘液性乳头状腺癌4例，子宫内膜样癌1例，低分化癌1例。全部病例均施行肿瘤细胞减灭术，术后予以铂类为主方案的化疗。27例中3例失访，余24例中位生存期为28个月。结论：PPC原发于腹膜，是一种起病隐袭、发病率较低的疾病。应重视其术前诊断及鉴别诊断，减少误诊率。对PPC采取肿瘤细胞减灭术及铂类的主方案的化疗可显著改善预后，延长生存期。     

腹膜假黏液瘤的诊断与治疗研究进展

摘 要：腹膜假黏液瘤是一种罕见的临床综合征，主要来源于阑尾黏液肿瘤，以腹腔内充满黏液或胶冻样腹水为特征。发病率每年约3/100万～4/100万。由于其进展缓慢，无特异性临床症状，容易导致误诊。超声、CT等影像学检查有助于诊断。目前细胞减灭术与腹腔热灌注化疗相结合的综合治疗策略已经成为腹膜假黏液瘤标准的治疗方法，然而术后高复发率仍是亟待解决的难题。肿瘤减灭程度是影响生存预后的重要因素，而全身化疗能否获益尚存在争议。     

卵巢外腹膜乳头状浆液性腺癌九例临床分析

对1995年1月～2002年12月本院收治的9例卵巢外腹膜乳头状浆液性腺癌的临床资料进行回顾性分析，其诊断均经病理学证实。所有病例均无特异性症状，术前无1例确诊(误诊率100％)。9例患者均为腹盆腔广泛种植的乳头状浆液性腺癌，3例病变累及卵巢表面。2例仅行肿瘤活检术，术后放弃化疗，分别存活3个月和7个月；7例行肿瘤减灭术后均接受6～8个疗程的CP/CAP方案化疗(C：环磷酰胺、A：多柔比星／表阿霉素、P：顺铂)，生存9～47个月。9例患者平均生存24个月。     

卵巢外腹膜浆液性乳头状癌的临床诊断与治疗

目的：探讨卵巢外腹膜浆液性乳头状癌(EPSPC)的临床诊断与治疗。方法：对1989年1月～2003年3月收治的、经病理检查证实的9例EPSPC的临床资料进行回顾性分析。结果：经采用肿瘤细胞减灭术及术后PC或PAC方案8个疗程的治疗，9例患中，除1例为术后1个月，4例失访，3例死亡，1例无瘤生存4年。结论：根据病史、临床表现与相关检查，EPSPC的术前诊断是可能的；肿瘤细胞减灭术与术后化疗可改善预后。     

恶性腹膜间皮瘤五例临床分析

目的　提高对恶性腹膜间皮瘤的认识。方法　结合文献复习 ,对 5例恶性腹膜间皮瘤的诊断及治疗进行讨论。结果　恶性腹膜间皮瘤术前诊断极为困难 ,常误诊为卵巢癌 ,最终确诊依据病理检查并结合免疫组化。治疗方案为肿瘤细胞减灭术 ,术后辅以化疗和放疗。结论　本病恶性程度高 ,预后差。综合治疗是提高恶性腹膜间皮瘤生存率的有效方法     

恶性腹膜间皮瘤五例临床分析

目的 提高对恶性腹膜间皮瘤的认识。方法 结合文献复习。对5例恶性腹膜间皮瘤的诊断及治疗进行讨论。结果 恶性腹膜间皮瘤术前诊断极为困难，常误诊为卵巢癌，最终确诊依据病理检查并结合免疫组化，治疗方案为肿瘤细胞减灭术，术后辅以化疗和放疗。结论 本病恶性程度高，预后差，综合治疗是提高恶性腹膜间皮瘤生存率的有效方法。     

卵巢外腹膜乳头状浆液性腺癌九例临床分析

对 1995年 1月～ 2 0 0 2年 12月本院收治的 9例卵巢外腹膜乳头状浆液性腺癌的临床资料进行回顾性分析 ,其诊断均经病理学证实。所有病例均无特异性症状 ,术前无 1例确诊 (误诊率 10 0 % )。 9例患者均为腹盆腔广泛种植的乳头状浆液性腺癌 ,3例病变累及卵巢表面。 2例仅行肿瘤活检术 ,术后放弃化疗 ,分别存活 3个月和 7个月 ;7例行肿瘤减灭术后均接受 6～ 8个疗程的CP/CAP方案化疗 (C :环磷酰胺、A :多柔比星 /表阿霉素、P :顺铂 ) ,生存 9～ 47个月。 9例患者平均生存 2 4个月     

晚期卵巢癌新辅助化疗疗效分析

目的 探讨新辅助化疗在治疗晚期卵巢癌中的作用和意义.方法 对45例晚期卵巢癌患者,20例采用新辅助化疗,然后进行肿瘤减灭术(新辅助化疗组);25例首先行肿瘤减灭术(先期手术组).所有患者术后均化疗.结果 新辅助化疗组满意肿瘤减灭率70.0%,先期手术组为36.0%,两组比较有明显差异(P＜0.05);新辅助化疗组术中出血量及手术时间较先期手术组少,两组比较均有明显差异(P＜0.05);新辅助化疗组的中位生存时间(34个月)较先期手术组(28个月)长.结论 对于初次手术不能达到满意减瘤或不能进行手术的晚期卵巢癌患者,新辅助化疗能提高减瘤术的成功率,有延长患者生存时间的趋势.     

18例原发性腹膜癌诊治分析

目的探讨原发性腹膜癌的临床特点、诊断标准、治疗方法及预后。方法对本院收治的18例原发性腹膜癌的临床资料进行回顾性分析，以腹胀、腹水、食欲差、消瘦为首发症状16例（88．89％）。18例均行肿瘤减灭术，病理为浆液性乳头状腺癌。术后给予铂类为主方案化疗6～8个疗程。结果随访＜2年2例，均无瘤生存；＞2年16例。总2年、3年、5年生存率分别为75％（12／16）、43．75％（7／16）、25％（4／16）。14例Ⅲ期患者2年、3年、5年生存率分别为78．57％（11／14）、50％（7／14）、28．57％（4／14），Ⅳ期2例，1例生存13个月，1例生存25个月；残存肿瘤＜2．0em和＞2．0em，2年生存率各为100％（9／9）和42．86％（3／7），3年生存率各为87．5％（7／9））和0，5年生存率各为44．45％（4／9）和0；腹腔化疗＋全身化疗与单纯全身化疗2年生存率各为90％（9／10）和50％（3／6），3年生存率各为70％（7／10）和0，5年生存率各为40％（4／10）和0。结论临床警惕腹胀、腹水患者原发腹膜癌的可能。积极减瘤术和以DDP为主腹腔化疗目前是原发性腹膜癌的最好方法。术前化疗有利于减瘤术。     

联合治疗原发性卵巢小细胞癌的预后分析

目的 探讨原发性卵巢小细胞癌的治疗方法.方法 5例原发性卵巢小细胞癌患者的临床资料.5例患者均采用手术切除、肿瘤细胞减灭术和术后不同的化疗方案治疗.结果 5例预后均很差.4例在2年内死亡,仅有1例生存27个月.结论 原发性卵巢小细胞癌是少见的妇科恶性肿瘤.恶性程度高,进展快,预后差,多在发病后1～2年内死亡.手术、联合化疗和放疗同时应用目前仍是原发性卵巢小细胞癌主要的治疗手段.     

Treatment of peritoneal carcinomatosis from colorectal cancer by cytoreductive surgery and hyperthermic perioperative intraperitoneal chemotherapy.

PURPOSE: Peritoneal carcinomatosis from colorectal cancer is resistant to standard treatments and median survival time for patients ranges between 6 and 8 months. Aggressive cytoreductive surgery with hyperthermic intraperitoneal perioperative chemotherapy may increase median survival. METHOD: Patients undergoing cytoreductive surgery and perioperative hyperthermic chemotherapy (mitomycin C, intraoperatively; 5-fluorouracil early post-operatively) for peritoneal carcinomatosis from colorectal cancer from 1996 to 2003 were evaluated retrospectively. RESULTS: From 1996 to 2003, 18 cytoreductive procedures were performed. The post-operative morbidity rate was 44.4% with no treatment related mortality. The median total operation time was 5 h 28 min (range: 3 h 20 min to 7 h 10 min). The median follow-up was 21 months. The median survival was 15 months. CONCLUSION: Surgical debulking and perioperative intraperitoneal chemotherapy improved survival with acceptable morbidity and mortality. Completeness of the resection was the most important prognostic indicator.     

三原发恶性肿瘤14例临床分析

目的:分析三原发恶性肿瘤的发病、诊断、治疗及预后情况.方法:回顾性分析14例三原发恶性肿瘤的临床资料,随访患者的生存状态.结果:男性 10 例,中位发病年龄67.5岁,女性4 例,中位发病年龄72岁;合并肿瘤相关家族史2 例,既往吸烟史 5例(全部为男性),中位吸烟指数600;第三原发肿瘤距离第二原发肿瘤间隔时间,7例<7个月,其余均大于24个月,第二原发肿瘤距离第一原发肿瘤间隔时间,3例<7个月,其余均大于15个月;消化系统恶性肿瘤发病部位占全部47.6%,发病率远高于其他部位;上皮性恶性肿瘤占全部发病部位的90.5%;治疗方法中手术为主的治疗比例为61.9%,以化疗、放疗等为主的综合治疗为26.2%,0.07%的病例放弃治疗,且均发生在诊断第三原发恶性肿瘤时;14例三原发恶性肿瘤患者中位生存时间184个月.结论:综合治疗有助于提高患者的总生存时间,早期发现及采用综合治疗手段可改善三原发恶性肿瘤患者的预后.     

恶性腹膜间皮瘤13例临床特点及诊治体会

目的：探讨恶性腹膜间皮瘤的临床特点、诊断方法和治疗方法及预后。方法：对13例经病理证实的恶性腹膜间皮瘤临床病例进行回顾性分析。结果：13例恶性腹膜间皮瘤中,主要临床表现为腹胀9例（69.2%）,腹痛6例（46.2%）;主要体征为腹水11例（84.6%）,腹部包块3例（27.3%）;血、腹水肿瘤标记物升高、渗出性腹水及影像学提示腹膜及网膜增厚是常见的客观特征,误诊率高（8例,61.5%）,确诊有赖于各种有创性方法获取病理证实。手术切除或行腹腔镜下减瘤术4例（30.8%）,腹腔化疗8例（61.5%）,全身化疗7例（53.8%）,其中4例腹腔化疗联合全身化疗。本组中位生存期仅2.8个月。结论：该病临床表现缺乏特异性,诊断应尽早并尽可能取腹膜病理活检,治疗应采用以手术、全身及或局部化疗为主的综合治疗方法。     

Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study.

PURPOSE: The three principal studies dedicated to the natural history of peritoneal carcinomatosis (PC) from colorectal cancer consistently showed median survival ranging between 6 and 8 months. New approaches combining cytoreductive surgery and perioperative intraperitoneal chemotherapy suggest improved survival. PATIENTS AND METHODS: A retrospective multicenter study was performed to evaluate the international experience with this combined treatment and to identify the principal prognostic indicators. All patients had cytoreductive surgery and perioperative intraperitoneal chemotherapy (intraperitoneal chemohyperthermia and/or immediate postoperative intraperitoneal chemotherapy). PC from appendiceal origin was excluded. RESULTS: The study included 506 patients from 28 institutions operated between May 1987 and December 2002. Their median age was 51 years. The median follow-up was 53 months. The morbidity and mortality rates were 22.9% and 4%, respectively. The overall median survival was 19.2 months. Patients in whom cytoreductive surgery was complete had a median survival of 32.4 months, compared with 8.4 months for patients in whom complete cytoreductive surgery was not possible (P <.001). Positive independent prognostic indicators by multivariate analysis were complete cytoreduction, treatment by a second procedure, limited extent of PC, age less than 65 years, and use of adjuvant chemotherapy. The use of neoadjuvant chemotherapy, lymph node involvement, presence of liver metastasis, and poor histologic differentiation were negative independent prognostic indicators. CONCLUSION: The therapeutic approach combining cytoreductive surgery with perioperative intraperitoneal chemotherapy achieved long-term survival in a selected group of patients with PC from colorectal origin with acceptable morbidity and mortality. The complete cytoreductive surgery was the most important prognostic indicator.     

31例腹膜后恶性纤维组织细胞瘤的诊疗经验

目的　探讨腹膜后恶性纤维组织细胞瘤 (MFH)的诊疗方法。方法　回顾性分析 31例腹膜后MFH的临床病理特点、治疗方法及其预后。结果　 31例患者男性 2 2例 ,女性 9例 ,平均年龄(5 2 .7± 14 .1)岁。主要临床表现为腹部肿块和腹痛 ,肿瘤平均直径为 (14 .9± 6 .6 )cm。组织学类型以炎症型 (16例 )和车辐状多形型 (10例 )多见。术后 1,3,5年生存率为 6 1.3%± 9.8% ,31.6 %± 11.3%和 2 1.1%± 11.4 % ,中位生存期为 (17.0± 6 .3)个月。手术切除的彻底性是影响术后生存期的主要因素。结论　腹膜后MFH治疗应以手术彻底切除为主 ,联合术后放化疗 ,可延长患者生存期     

Treating peritoneal mesothelioma with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A case series and review of the literature

Abstract

Background: Encouraging results on survival of patients with malignant peritoneal mesothelioma have been shown with the use of cytoreductive surgery and perioperative intraperitoneal chemotherapy. This study explores the impact of aggressive surgical treatment on overall survival of peritoneal mesothelioma. Methods: This is a retrospective analysis of prospectively collected clinical data of all patients with diagnosis of malignant peritoneal mesothelioma treated in a designated referral centre in Greece. All patients were offered cytoreductive surgery and intraperitoneal chemotherapy. Patient’s characteristics, operative reports, pathology reports, and discharge summaries were stored in an electronic database and later reviewed and analysed. Results: Cytoreduction for peritoneal mesothelioma was performed on 20 patients (15 men and 5 women) with a mean age of 59.4 years (SD 16.1). Mean peritoneal cancer index was 16.1 (SD 10.4) and the median completeness of cytoreduction score was 2 (range 1–2). Mean overall survival was 46.8 months (SE 4.03) with a mean of 21.4 and median of 18 months of follow-up. Disease-specific survival was 100% for the observed period. Univariate analysis showed the completeness of cytoreduction as the only possible predictor of survival. A median of 10 (range 4–14) peritonectomy procedures were performed per patient. Median hospital stay was 14 (range 10–57 days). Grade III and IV complications occurred post-operatively in 5 patients (25%). Two patients died in the post-operative period of pulmonary embolism and myocardial infarction. Conclusion: Cytoreductive surgery with HIPEC has proved the most effective treatment even when taking account of the cost of significant morbidity.     

The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma

BACKGROUND: This study examined the impact of secondary cytoreductive surgery on survival of patients with recurrent epithelial ovarian carcinoma. METHODS: One hundred six patients with a disease free interval (DFI) > 6 months after primary treatment underwent secondary cytoreductive surgery. Multivariate analysis determined which variables influenced the cytoreductive outcome and survival. RESULTS: Eighty-seven patients (82.1%) underwent removal of all visible tumor. The median and estimated 5-year survival for the entire cohort after recurrence was 35.9 months and 28%, respectively. The probability of complete cytoreduction was influenced by the largest size of recurrent tumor (< 10 cm ?90.0% vs. > 10 cm ?66.7%; P = 0.003), use of salvage chemotherapy before secondary surgery (chemotherapy given ?64.3% vs. chemotherapy not given ?93.8%; P = 0.001), and preoperative Gynecologic Oncology Group performance status (0 ?100%, 1 ?91.4%, 2 ?82.4%, and 3 ?47.4%; P = 0.001). Survival was influenced by the DFI after primary treatment (6-12 months ?median, 25.0 months vs. 13-36 months ?median, 44.4 months vs. > 36 months ?median, 56.8 months; P = 0.005), the completeness of cytoreduction (visibly disease free ?median, 44.4 months vs. any residual disease ?median, 19.3 months; P = 0.007), the use of salvage chemotherapy before secondary surgery (chemotherapy given ?median, 24.9 months vs. chemotherapy not given ?median, 48.4 months; P = 0.005), and the largest size of recurrent tumor (< 10 cm ?median, 37.3 months vs. > 10 cm ?median, 35.6 months; P = 0.04). CONCLUSIONS: Complete cytoreduction is possible for the majority of patients with recurrent epithelial ovarian carcinoma and maximizes survival if undertaken before salvage chemotherapy. The authors believe a randomized trial should be initiated to confirm these findings.     

Role of Neoadjuvant Chemotherapy in the Management of Advanced Ovarian Cancer

Objective: To analyze efficacy of neoadjuvant chemotherapy for advanced ovarian cancer. Materials andMethods: A total of 107 patients with advanced ovarian cancer undergoing cytoreductive surgery were dividedinto a neoadjuvant chemotherapy group (n=61) and a primary debulking group (n=46) and retrospectivelyanalyzed. Platinum-based adjuvant chemotherapy was applied to both groups after cytoreductive surgery andeoverall and progression-free survival times were calculated. Results: No significant difference was observed induration of hospitalization (20.8±6.1 vs. 20.2±5.4 days, p>0.05). The operation time of neoadjuvant chemotherapygroup was shorter than the initial surgery group (3.1±0.7 vs. 3.4±0.8 h, p<0.05). There were no significantdifferences in median overall survival time between neoadjuvant chemotherapy group and surgery group (42 vs.55 months, p>0.05). Similarly, there was no difference in median progression-free survival between neoadjuvantchemotherapy group and surgery group (16 vs. 17 months, p>0.05). The surgical residual tumor size demonstratedno significant difference between initial surgery and neoadjuvant chemotherapy groups (p>0.05). Multivariateanalysis showed that more than 3 cycles of regimen with neoadjuvant chemotherapy was associated with moreresistance to chemotherapy compared with patients without receiving neoadjuvant chemotherapy (OR: 5.962,95%CI: 1.184-30.030, p<0.05). Conclusions:Neoadjuvant chemotherapy can shorten the operation time. However,it does not improve survival rates of advanced ovarian cancer patients.     

卵巢原发性恶性淋巴瘤7例临床分析

目的 :探讨卵巢原发性恶性淋巴瘤的临床特点和治疗方法。方法 :回顾性分析 1980年 1月 -2 0 0 0年 12月收治的 7例卵巢原发性淋巴瘤 ,均行手术切除和CHOP化疗 ,2例配合盆腔外照射治疗。结果 :中位年龄 30岁 ,首发症状为盆腹腔肿块 ,1例合并不典型B类症状 ,病理类型全部为NHL ,来源于B细胞 ,中度恶性 ,中位生存期 37个月。结论 :已婚育的年轻妇女为卵巢原发性恶性淋巴瘤的高发年龄。治疗宜采用以手术为主的综合治疗 ,疗效优于卵巢以外的NHL。