初治卵巢癌的手术治疗课件.ppt

cisplatin paclitaxel multi-drug Alkeran Median Survival: 1975 - 2008 IP therapy months 0 20 40 60 80 1975 1983 1986 1996 1998 2003 2006 Advanced Ovarian Cancer 预测满意细胞减灭术的因素 预测患者是否能达到理想手术减瘤：没有单个可靠的指标 术前CA-125水平和预测手术减瘤结果的准确率只有50%-78% CT的13种X线特征和体力状态与预测减瘤状态的准确率达到93% (Bristow et al) 仅CT特征中的“弥漫性腹膜加厚”是不理想减瘤的独立预测因素 (Dowdy et al) 临床结果与肿瘤生物学特征有关 卵巢癌的遗传基础 (基因特征预测手术减瘤还是新辅助化疗？) Fader AN and Rose PG, J Clin Oncol 2007; 25(20):2873-2883. CT预测的准确性无法得到验证 (Axtell et al) 腹腔镜预测理想细胞减灭术的可能性，但是至今仍无法应用到不同的机构 晚期卵巢癌淋巴结切除术对生存率影响 Burghardt认为：卵巢癌腹膜后淋巴结转移率高；未行淋巴清扫术的患者接受化疗后淋巴结复发可能性高；淋巴结清扫应是卵巢癌手术的必要步骤之一 一项比较淋巴结清扫与仅切除肿大淋巴结的前瞻性研究表明，淋巴结清扫只延长PFS而OS未受益，手术时间却相应延长，失血量增加。 细胞减灭术对IV期患者的作用存在争议 SCOTROC-1试验：仅有中晚期患者才能受益于理想细胞减灭术 最近数据：即使出现腹膜外转移，理想减灭术后的患者能显著改善生存 Fader AN and Rose PG, J Clin Oncol 2007; 25(20):2873-2883. 晚期卵巢癌细胞减灭术——争议 vs. vs. 谢谢 Dr. Xiaohua Wu * 从发病趋势来看，卵巢癌也在增长。 * 明显早期：Stage IA, G1 or G2，低危肿瘤包括：生殖细胞肿瘤、低度恶性潜能的卵巢肿瘤，早期浸润性上皮肿瘤或性索间质肿瘤 * * Many patients had more than one upper abdominal surgical procedure, with the two most common, diaphragm peritonectomy and splenectomy, being performed in 101 and 45 patients, respectively. Full thickness diaphragm resection, partial hepatectomy, distal pancreatectomy, cholecystectomy, and resection of porta hepatis tumor were each performed in 10-14% of patients. * The majority of patients had primary ovarian cancer, FIGO stage IIIC disease, grade 3 tumors, and serous histology, 131 (93%). Although not shown 118 patients or 84% had ascites at presentation. * Three patients had unplanned admission to the ICU due to aspiration pneumonia, acute respiratory failure, and GI bleeding requiring endoscopic evaluation. All 3 patients were able to be discharged from the ICU after successful management of their acute conditions. * There were no grade 4 complications. There were two mortalities within 30 days of surgery for a postoperative mortality rate of 1.4%. The first was a 68 year old who develo