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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (06) : 325 -330. doi: 10.3877/cma.j.issn.1674-6899.2023.06.002

论著

Ⅳ期卵巢癌患者经微创或开腹行间歇性肿瘤细胞减灭术的临床分析
张同乐, 王铭洋, 李立安, 孟元光, 叶明侠†()   
  1. 100853　北京，中国人民解放军总医院第一医学中心妇产科；300071　天津，南开大学医学院
    100853　北京，中国人民解放军总医院第一医学中心妇产科
  • 收稿日期:2023-11-03 出版日期:2023-12-30
  • 通信作者: 叶明侠
  • 基金资助:
    国家重点研发计划(2017YFC0110405)

Clinical analysis of interval debulking surgery via MIS versus laparotomy in stage IV ovarian cancer patients

Tongle Zhang, Mingyang Wang, Li′an Li, Yuanguang Meng, Mingxia Ye†()   

  1. Department of Gynecology and Obstetrics, the First Medical Center of Chinese People′s Liberation Army (PLA) General Hospital, Beijing 100853, China; School of Medicine, Nankai University, Tianjin 300071, China
    Department of Gynecology and Obstetrics, the First Medical Center of Chinese People′s Liberation Army (PLA) General Hospital, Beijing 100853, China
  • Received:2023-11-03 Published:2023-12-30
  • Corresponding author: Mingxia Ye
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引用本文：

张同乐, 王铭洋, 李立安, 孟元光, 叶明侠. Ⅳ期卵巢癌患者经微创或开腹行间歇性肿瘤细胞减灭术的临床分析[J]. 中华腔镜外科杂志(电子版), 2023, 16(06): 325-330.

Tongle Zhang, Mingyang Wang, Li′an Li, Yuanguang Meng, Mingxia Ye. Clinical analysis of interval debulking surgery via MIS versus laparotomy in stage IV ovarian cancer patients[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2023, 16(06): 325-330.

目的

比较Ⅳ期卵巢癌患者经微创(minimally invasive surgery, MIS)与开腹方式行间歇性肿瘤细胞减灭术(interval debulking surgery, IDS)的围术期指标和生存结局。

方法

本研究采用回顾性研究方法，纳入2017年1月至2021年12月在解放军总医院第一医学中心行IDS所有确诊为Ⅳ期卵巢癌的患者98例，根据手术方式分为开腹组74例和微创组24例，收集两组患者的围术期临床指标并进行随访，比较两组临床疗效和生存结局。

结果

微创组与开腹组IDS患者的临床基线均衡可比，两组的术中操作、手术时间和术后残留病灶的差异无统计学意义。微创组比开腹组预估失血量更少，术中输血率更低，术后恢复和开始辅助化疗的时间更短(以上均P<0.001)。共82.7%患者通过IDS达到满意的肿瘤细胞减灭效果，微创组与开腹组的术后残留病灶差异无统计学意义(P<0.05)。微创组患者的医疗费用更高(P<0.001)。两组患者的无进展生存期和总生存期差异无统计学意义(P＝0.998和P＝0.592)。

结论

对于新辅助化疗(neoadjuvant chemotherapy，NACT)后行IDS的Ⅳ期卵巢癌患者，经过评估后选择微创IDS是技术上可行的手术方式，能达到满意的肿瘤细胞减灭效果，并且能减少术中出血及损伤，缩短术后恢复时间和开始化疗的时间，在一定程度上使患者获益。

关键词: 卵巢癌, 间歇性肿瘤细胞减灭术, 微创手术, Ⅳ期卵巢癌
Objective

This study aimed to assess perioperative and survival outcomes of minimally invasive surgery(MIS) compared to standard laparotomy interval debulking surgery(IDS) for stage IV ovarian cancer.

Methods

A retrospective study was applied in this study. All patients diagnosed with stage IV ovarian cancer who underwent IDS at the People′s Liberation Army General Hospital from Jan. 2017 to Dec. 2021 were included. According to surgical approaches, patients were divided into laparotomy(n=74) and MIS(n=24) cohorts. We collected perioperative indicators and follow-up information and then made statistical analyses to compare clinical efficacy and survival outcome.

Results

The clinical baseline of IDS patients in the MIS cohort was comparable to that the open cohort. No statistical differences were observed for surgical procedures, operation time and residual diseases. Compared with the laparotomy group, the MIS group had more favorable estimated blood loss, transfusion rate, duration of postoperative recovery and adjuvant chemotherapy(above P<0.001) as well as fewer intraoperative complications (P<0.05). 82.7% of the whole were optimally cytoreductive and there was no significant difference in residual diseases(P<0.05). Nevertheless, MI-IDS patients afforded higher medical expense(P<0.001). Besides, progression-free survival and overall survival had no statistical difference(P=0.998 and 0.592, respectively).

Conclusion

For stage IV ovarian cancer patients after NACT, minimally invasive IDS could represent a technically feasible alternative surgical choice with optimal cytoreduction. It could reduce intraoperative bleeding and injury, shorten postoperative recovery duration and time to chemotherapy, which benefit patients to some extent.

Key words: Ovarian cancer, Interval debulking surgery, Minimally invasive surgery, Stage Ⅳ ovarian cancer
图1 患者纳入、排除流程图
表1 开腹组与微创组患者术前基线特征比较
基线特征 开腹组(n＝74) 微创组(n＝24) t/χ2/Z值 P值
年龄(岁，±s) 55.0±10.3 54.5±11.4 0.201 0.841
BMI(kg/m2，±s) 23.7±3.2 22.9±2.5 1.178 0.242
ASA评分[例(%)]     0.360 0.549
2 67(90.5) 20(83.3)    
3 7(9.5) 4(16.7)    
肿瘤病史[例(%)] 5(6.8) 1(4.2) 0.000 >0.999
盆腹部手术史[例(%)] 37(50) 12(50) 0.000 >0.999
确诊时CA125(UI/ml) 1000(422，2170) 1749(804，3413) －2.359 0.018
术前CA125(UI/ml) 46.5(15.1，154.2) 70.4(24.2，167.2) －0.537 0.591
NACT程数(±s) 2.7±1.1 3.4±1.7 －1.776 0.076
Ⅳ期证据[例(%)]     3.302 0.192
胸腔积液 9(12.2) 1(4.2)    
腹腔脏器实质 18(24.3) 10(41.7)    
腹膜外转移 47(63.5) 13(54.2)    
浆液性癌[例(%)] 70 (94.6) 22 (91.7) 0.001 0.976
表2 开腹IDS与微创IDS术中相关指标比较
指标 开腹组(n＝74) 微创组(n＝24) t/χ2/Z值 P值
妇科手术操作[例(%)]     0.304 0.582
(全子宫)双附件大网膜切除术 59(79.7) 21(87.5)    
(全子宫)双附件大网膜切除及淋巴结清扫术 15(20.3) 3(12.5)    
减瘤手术分类[例(%)]     1.202 0.627
Ⅰ类 61(82.4) 22(91.7)    
Ⅱ类及以上 12(16.2) 2(8.3)    
手术时长(min，±s) 257±93 294±105 －1.684 0.095
术中出血量(ml) 600(400，1000) 200(100，300) －5.219 <0.001
术中输血[例(%)] 48(64.9) 3(12.5) 19.910 <0.001
术中并发症[例(%)] 13(17.6) 0(0) 3.454 0.063
残留病灶[例(%)]     3.328 0.189
R0 49(66.2) 12(50)    
R1 15(20.3) 5(20.8)    
R2 10(13.5) 7(29.2)    
表3 三组术后恢复指标和费用比较
指标 开腹组(n＝74) 微创组(n＝24) t/χ2/Z值 P值
肛门排气时间(d) 3.00(2.50，4.00) 2.00(1.25，3.00) －4.062 <0.001
术后住院时间(d) 12(10，16) 9(8，11) －3.967 <0.001
术后化疗时间(d) 10(9，14) 7(6，9) －5.049 <0.001
术后并发症[例(%)] 36(48.6) 8(33.3) 1.718 0.190
手术费用(元，±s) 8728±7065 23304±17510 －3.518 <0.001
住院费用(元，±s) 61625±24912 66969±19174 －1.733 0.083
图2 开腹IDS组和微创IDS组术后PFS生存分析函数
图3 开腹IDS组和微创IDS组术后OS生存分析函数
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