卵巢恶性肿瘤二次剖腹探查术中行腹膜后淋巴结清除术的研究

目的　探讨卵巢恶性肿瘤腹膜后淋巴结清除术的最佳时机和临床价值。方法　回顾性分析了 5 0例二次剖腹探查术 (SLL)中行腹膜后淋巴结清除术的卵巢恶性肿瘤患者的临床资料。结果　患者中位数年龄 49岁 ,其 3年和 5年生存率分别为 72 %和 62 %。SLL阳性率为 40 % ( 2 0 / 5 0 ) ,其中临床分期 [国际妇产科联盟 (FIGO)标准 ]Ⅰ期SLL阳性率为 0 % ( 0 / 15 ) ,Ⅱ期和Ⅲ期分别为 40 %( 4/ 10 )、62 % ( 15 / 2 4) ,Ⅳ期为 1例中 1例。SLL阳性率与临床分期的期别呈正相关 ,其中Ⅰ～Ⅱ期( 16% ,4/ 2 5 )和Ⅲ～Ⅳ期 ( 64 % ,16/ 2 5 )患者SLL阳性率比较 ,差异有极显著性 (P <0 0 1)。腹膜后淋巴结转移率为 3 2 % ( 16/ 5 0 ) ,其中Ⅰ、Ⅱ、Ⅲ期分别为 0 % ( 0 / 15 )、2 0 % ( 2 / 10 )、5 4% ( 13 / 2 4) ,Ⅳ期为 1例中1例。SLL阳性患者中 ,4例 ( 8% )仅盆腹腔内有转移灶 ,淋巴结无转移 ;6例 ( 12 % )仅显微镜下淋巴结转移 ,而无盆腹腔转移灶。SLL中 ,行二次肿瘤细胞减灭术共 2 0例 ,其中术后 13例残留灶直径≤ 0 5cm ,7例残留灶直径 >0 5cm。中位数随访时间 44个月 ( 2 4～ 10 4个月 ) ,至随访截止日SLL阴性者 ( 3 0例 )均无肿瘤复发。结论　腹膜后淋巴结清除术在SLL术中进行比较合理 ,而且对降低SLL阴性患

Significance of systematic retroperitoneal lymphadenectomy at second-look laparotomy for ovarian cancer

OBJECTIVE: To investigate the timing and role of systemic retroperitoneal lymphadenectomy in patients with ovarian cancer. METHODS: From Jan. 1987 to Feb. 1994, 50 patients with ovarian cancer, who underwent retroperitoneal lymphadenectomy on second-look laparotomy (SLL), were retrospectively studied. RESULTS: The median age was 49 years. Overall survival at 3 and 5 years were 72% and 62%, respectively. Twenty of 50 (40%) women were found SLL(+), and the rates of positive SLL were related to International Federation of Gynecology Obstetrics (FIGO) stage, with 16% in stage I and II, 64% in stage III and IV (P < 0.01). Sixteen (32%) women were found to have retroperitoneal lymph nodes metastases at SLL, with 0% (0/15), 20% (2/10), 54% (13/24), 1/1 in stage I, II, III, IV respectively. In patients with SLL(+), 4 patients with sole disease in the pelvis, and 6 (12%) women only with micro-metastases of retroperitoneal lymph nodes. Fifteen patients with stage I ovarian cancer were all SLL(-), and SLL(-) were in 6 (60%) patients with stage II disease and 11 (38%) in stage III. There is no disease recurrence in patients with negative SLL till the data censored. CONCLUSION: Timing of systemic retroperitoneal lymphadenectomy at SLL is rational, and may aid in reducing disease recurrence of negative SLL and improving five-year survival rate in patients with ovarian cancer, especially in those with advanced epithelial ovarian cancer.