卵巢上皮癌首次术中残留肿瘤组织最大径超过2 cm患者的治疗与预后.docVIP

卵巢上皮癌首次术中残留肿瘤组织最大径超过2 cm患者的治疗与预后 北京医科大学学报 1999年第4期第31卷 论著 作者：魏丽惠　钱和年　崔　恒　富　琪　屠　铮　虞　幸 单位：北京医科大学人民医院妇科肿瘤中心，北京　100044 关键词：卵巢肿瘤；外科手术；残留癌☆；再手术；肿瘤；腺和上皮；外科手术；抗肿瘤药；治疗应用 　　摘　要　目的：对北京医科大学人民医院1970～1994年首次术中残留肿瘤组织最大径超过2 cm的69例卵巢上皮癌患者的治疗与预后进行回顾性分析。方法：69例卵巢上皮癌中浆液性癌54例、粘液性癌10例、内膜样癌4例、透明细胞癌1例，其中Ⅱ期1例、Ⅲ期64例、Ⅳ期4例。全部先行手术，确定组织类型、临床分期。22例行第2次手术；7例行第3次手术 。首次术后67例进行了全身和腹腔化疗，2、3次术后对复发者又进行了全身化疗；对复发者中出现远处转移的9例患者除进行全身化疗，还进行了局部化疗，6例肺转移并出现胸水者加用了胸腔局部化疗， 2例肝转移行肝动脉化疗，2例脑转移者行开颅术后全身化疗。结果：69例中2年存活32例(50.7%)；5年存活11例(28.1%)；10年存活3例 ，生存率14.8%。6例肺转移合并胸水者，平均延长生存7个月（2～12月）； 2例肝转移者分别延长生存9及29个月；2例脑转移者分别延长生存5、16个月。结论：在卵巢癌首次术中应尽可能切除肿瘤组织，对残留肿瘤组织最大径超过2 cm患者术后应积极化疗，对复发者应再次手术，化疗可延长患者生命。 　　 中国图书资料分类法分类号　R737.31 The epithelial ovarian carcinoma with residual disease of more 　　than 2 cm after cytoreductive initial surgery WEI Li-Hui, QIAN He-Nian, CUI　Heng, FU Qi, TU Zheng, YU Xing 　　(Gynecologic Oncologic Center , Peoples Hospital , Beijing Medical University, Beijing　100044) 　　ABSTRACT　Objective: To retrospectively study the treatment and prognosis of 69 cases of ovarian carcinoma with residual disease of more than 2 cm after cytoreductive initial surgery.Methods: Among the 69 cases, 54 were serous carcinoma, 10 mucinous, 4 endometrioid， 1 clear cell carcinoma. One was found to be FIGO stage Ⅱ, 64 stage Ⅲ and 4 stage Ⅳ. The histologic classification and surgical staging were determined at the time of the initial surgery. Second cytoreduction was done for 22 cases and, 7 third surgery. Systemic and introperitoneal chemotherapy was used in 67 cases following primary surgery. Systemic chemotherapy was used on the recurrent cases following second and third operations. Local chemotherapy was added to 9 cases with distant metastasis, in which, intra-thoracic chemotherapy was used for 6 cases with lung metastasis, 2 cases with intra-arterial chemotherapy for hepatic metastasis, and systemic chemotherapy for one case of cerebral metastasis following cerebral operation.Results: The survival rates were 50.7%,28.1% and 14.8% f