复发性卵巢上皮性癌再次手术的临床评价

目的　探讨复发性卵巢上皮性癌 (卵巢癌 )再次手术的指征及临床意义。方法　复发性卵巢癌再次手术的患者 5 5例 ,术前及术后均进行化学药物治疗 (化疗 )或放射治疗 (放疗 ) ,再次手术共 6 8例次。根据再次手术前不同病灶的性质分为 4组 ,即单个复发灶组、多个复发灶组、因肠梗阻手术组及姑息性手术组。并根据再次手术前对化疗的敏感程度分为 3组 ,即≤ 6个月复发组、>6个月复发组及肿瘤进展组。观察每组再次手术中进行满意的肿瘤细胞减灭术的例数、手术并发症的例数及手术治疗的有效率、生存时间、疾病缓解时间。结果　再次手术前通过检查认为是单个复发灶者 ,6 1%在再次手术中发现为多个复发灶 ;单个复发灶组中获得较满意的肿瘤细胞减灭术的为 6 7% ,术前认为是单个复发灶者而在再次手术中确诊为多个复发灶者中 ,获得较满意的肿瘤细胞减灭术的为6 4 % ;多个复发灶组获得满意的肿瘤细胞减灭术的为 4 3%。再次手术治疗的有效率 ,以单个复发灶组最高 ;手术后疾病缓解时间及生存时间 ,也以单个复发灶组最长 ;单个复发灶组手术并发症少于多个复发灶组。获得满意的肿瘤细胞减灭术 ,停止化疗 >6个月复发组为 73% ;≤ 6个月复发组为80 % ;肿瘤进展组为 5 0 %。结论　单个复发灶组、停止化疗 >6个月复发组再次手

Recytoreductive surgery for recurrent epithelial ovarian cancer

Objective To evaluate the roleof recytoreductive surgery(RCRS) in recurrent epithelial ovarian cancer. Methods Fifty-five patients who underwent recytoreductive surgery at Peking Union Medical College Hospital between Nov. 1998 and Apr.2002 were retrospectively reviewed. They were divided into four groups firstly by the identity of recurrent lesion: group A,single lesion;B,disseminated lesion;C,intestinal obstruction;D,palliative surgery. Then they were divided into 3 groups according to the sensitivity to chemotherapy. Group A,diseases relapsed more than 6 months after chemotherapy;group B,relapsed less than 6 months;group C,relapsed during chemotherapy. We review the cases with regard to its macroscopic residual disease,complications of operation,cases with complete remission and partial remission,postoperation survival time and disease-free interval. Results Recytoreductive surgery for patients with isolated recurrent tumor were optimal. For those diagnosed as local lesion preoperatively,61% of thsee cases were found to have disseminated diseases postioeratively. Sixty-five percents of these cases recieved optimal RCRS,but their prognosis were not as well as those with real isolated leasion(response rate: 36% vs 67%). Cases with different sensitivity to chemotherapy had different prognosis(response rate: A,50%;B,26%;C,28%). Conclusion Recytoreductive surgery should be considered in patients with isolated recurrent ovarian cancer and patient with recurrence more than 6 months after chemotherapy.