卵巢癌术后复发并肠梗阻的外科处理

目的探讨卵巢癌术后复发并肠梗阻病人的外科理念及术中操作技巧。方法回顾性分析2007年3月至2012年3月46例卵巢癌术后复发并肠梗阻病人,年龄48~68岁,平均年龄55.5岁。病人均有腹胀、腹痛、停止排气排便等临床症状。胸腹部CT提示:44腹盆腔肿瘤转移;2例胸腔有转移灶;术前腹部平片均提示肠梗阻。术前病理明确,均为卵巢腺癌,二次手术前行PT方案化疗6个周期。分析该类疾病的临床特点,总结外科临床处理经验与教训,归纳该类疾病的外科处理及术中操作技巧。结果 46例卵巢癌术后复发并肠梗阻病人中,31例病人肉眼观完整切除肿瘤,切除率为67.4%。11例病人术后腹腔肿瘤结节小于1.0 cm,占23.9%。4例仅行小肠中段造瘘,占8.7%。42例二次减瘤病人,手术时间平均为150.9 min,术中出血平均为450.4 ml。术后病人腹腔感染2例,无死亡。结论多数卵巢癌术后复发并肠梗阻病人仍具有肿瘤整体切除或有效减瘤的机会,术前应多学科联合给予论证,不轻易放弃手术或局限于单纯肠造瘘。

Treatment philosophy and operating skills of patients with recurrent epithelial ovarian carcinoma and in-testinal obstruction

Objective To investigate the treatment philosophy and operating skills of the pa-tients with recurrent epithelial ovarian carcinoma and intestinal obstruction.Methods The clinical data of 46 patients with recurrent epithelial ovarian carcinoma and intestinal obstruction were analyzed ret-rospectively from March 2007 to March 2012.The clinical features of disease were analyzed,and the clinical and surgical treatment experiences and lessons,and the philosophy and technique of surgical treatment of such diseases in the operating skills were summarized.Results Of the 46 cases,31 pa-tients were subjected to total tumor resection,accounting for 67.4%.Eleven patients had the abdomi-nal tumor nodules less than 1.0 cm,accounting for 23.9%.Four cases were subjected to the middle jejunal fistula,accounting for 8.7%.The average operative time of 42 cases undergoing tumor-reduc-ing reoperations was 150.9 min,and the mean blood loss was 450.4 mL.There were 2 cases of post-operative abdominal infection.Conclusions Most of the patients with recurrent epithelial ovarian carci-noma and intestinal obstruction have the chance of total tumor resection or tumor-reducing reopera-tions.