腹腔镜与开腹手术治疗巨大卵巢肿瘤

目的探讨巨大卵巢囊肿微创、安全的治疗方式。方法回顾性分析我院2010年10月～2013年10月采用腹腔镜手术或开腹手术治疗37例直径≥10cm卵巢肿瘤的临床资料，其中21例行腹腔镜手术为腹腔镜组，16例行开腹手术为开腹组。比较2组手术时间、术中出血量、囊液量、术后肛门排气时间、并发症、住院时间。对比术前B超、术中快速冰冻病理及术后病理。结果与开腹组比较，腹腔镜组术中出血少（60．0±25．7）mlVS．（115．7±88．4）ml，t=-2．677，P=0．012]，术后24h排气率高95．0％（19／20）VS．57．1％（8／14），P=0．012]、术后住院时间短（5．0±1．4）d VS．（7．9±2．1）d，t=-4．841，P=0．000]；腹腔镜组手术时间略短于开腹组（76．5±21．4）min vs．（89．6±24．4）min]，但无统计学差异（t=-1．659，P=0．107）。2组囊液量（2204．8±1457．9）ml VS．（2537．5±1401．3）ml，t=-0．665，P=0．511]、囊液外漏发生率10．0％（2／20）vs．14．3％（2／14），P=1．000]、术后病率5．0％（1／20）vs．35．7％（5／14），P=0．061]无显著性差异。B超诊断准确率89．2％（33／37），冰冻切片漏诊率50．0％（2／4）。结论在严格选择病例的前提下，对巨大卵巢囊肿进行腹腔镜手术具有手术出血少，术后恢复快等优点，安全可行；术中应警惕卵巢交界性肿瘤的可能。

Comparison of Laparoscopy and Laparotomy for Large Ovarian Cysts

Objective To explore a safe and minimally invasive procedure for large ovarian cysts. Methods A retrospective analysis was carried out on 37 patients with large ovarian cysts （equals to or more than 10 cm in diameter）, who underwent cystectomy or enucleation by laparoscopy （21 cases） or laparotomy （16 cases） in our hospital from October 2010 to October 2013. The operative time, intraoperative blood loss, volume of cystic fluid, bowel function recovery time, complications and postoperative hospital stay were compared between the two groups. Preoperative color dopolor uhrasonography, intraoperative frozen section examination and postoperative pathology were also recorded and compared. Results Compared with the laparotomy group, the laparoscopy group had significantly less intraoperative blood loss （60.0 ± 25.7） ml vs. （ 115.7 ± 88.4） ml, t = - 2. 677, P = 0. 0123, higher incidence rate of bowel function recovery 24 h postoperatively 95.0% （19/20） vs. 57.1% （8/14）, P = 0. 012 ], shorter postoperative hospital stay （5.0 ± 1.4） d vs. （7.9 ± 2.1 ） d, t = - 4. 841, P = 0. 000 ]. No significant differences were found in operative time （76.5 ±21.4） rain vs. （89.6 ±24.4） min, t = -1.659, P=0. 107], volume of cystic fluid （2204.8 ± 1457.9） ml vs. （2537.5 ±1401.3） ml, t= -0.665, P=0.511],postoperative morbidity 5.0% （1/20） vs. 35.7% （5/14）, P = 0. 061 ], and incidence of overflow of cystic fluid 10.0% （2/20） vs. 14.3% （2/14）, P = 1. 000] between the two groups. The diagnostic accuracy rate of preoperative uhrasonography was 89.2% （33/37） , and the rate of misdiagnosis of frozen section was 50.0% （2/4）. Conclusions For strictly selected cases, laparoscopy is effective for large ovarian cysts, with the advantages of less intraoperative blood loss and shorter postoperative recovery. Surgeons are advised to be alert for borderline ovarian tumors.