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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) ›› 2024, Vol. 17 ›› Issue (03) : 177 -181. doi: 10.3877/cma.j.issn.1674-6899.2024.03.010

临床技术

经脐单孔腹腔镜联合上腹部开腹行晚期卵巢癌肿瘤细胞减灭术
蒋露1, 郑莹1,†(), 杨帆1, 王乔1, 王娜1, 阳川华2, 陈宇1, 苟嘉妮1, 邓露丝1, 杨旭1   
  1. 1. 610041　成都，四川大学华西第二医院妇科；610041　成都，出生缺陷与相关妇儿疾病教育部重点实验室
    2. 610041　成都，四川大学华西第四医院胃肠外科
  • 收稿日期:2024-02-22 出版日期:2024-06-30
  • 通信作者: 郑莹
  • 基金资助:
    国家重点研发计划(2022YFC2704103); 四川省科技厅重点研发项目(23ZDYF1628)

Surgery for advanced epithelial ovarian cancer by transumbilical laparoendoscopic single-site surgery combined with upper abdominal laparotomy

Lu Jiang1, Ying Zheng1,†(), Fan Yang1, Qiao Wang1, Na Wang1, Chuanhua Yang2, Yu Chen1, Jiani Gou1, Lusi Deng1, Xu Yang1   

  1. 1. Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, Chengdu 610041, China; The Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu 610041, China
    2. Gastroenterology Department of West China Fourth Hospital of Sichuan University, Chengdu 610041, China
  • Received:2024-02-22 Published:2024-06-30
  • Corresponding author: Ying Zheng
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引用本文：

蒋露, 郑莹, 杨帆, 王乔, 王娜, 阳川华, 陈宇, 苟嘉妮, 邓露丝, 杨旭. 经脐单孔腹腔镜联合上腹部开腹行晚期卵巢癌肿瘤细胞减灭术[J]. 中华腔镜外科杂志(电子版), 2024, 17(03): 177-181.

Lu Jiang, Ying Zheng, Fan Yang, Qiao Wang, Na Wang, Chuanhua Yang, Yu Chen, Jiani Gou, Lusi Deng, Xu Yang. Surgery for advanced epithelial ovarian cancer by transumbilical laparoendoscopic single-site surgery combined with upper abdominal laparotomy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(03): 177-181.

目的

探讨经脐单孔腹腔镜联合上腹部开腹行晚期卵巢癌肿瘤细胞减灭术的可行性、减瘤效果及手术安全性。

方法

回顾性分析2022年3月至2023年8月6例行经脐单孔腹腔镜联合上腹部开腹的晚期卵巢癌患者的手术方式和短期结局。

结果

6例患者手术均成功完成，且均达满意缩瘤(即达R0)。平均手术时间为417.50±103.09 min，平均手术出血量为566.67±273.25 ml，术后平均住院天数6.5±0.837 d，仅1例患者发生术后淋巴囊肿。6例患者术后均如期进行后续化疗。

结论

经脐单孔腹腔镜联合上腹部开腹手术方式保证晚期卵巢癌肿瘤细胞减灭术达R0的前提下，具有创伤最小化的优势，降低围手术期并发症，对患者快速康复和及时后续治疗有积极作用。这种联合手术方式是安全可行的。

关键词: 经脐单孔腹腔镜, 卵巢癌, 联合上腹部开腹手术
Objective

This study aims to investigate the feasibility and safety of debulking surgery(DS) via transumbilical laparoendoscopic single-site(TU-LESS)approach combined with upper abdominal laparotomy in advanced ovarian cancer.

Methods

Retrospective analysis of the perioperative outcomes of patients with advanced ovarian cancer who underwent TU-LESS combined with upper abdominal laparotomy from Mar. 2022 to Aug. 2023 in a single institution.

Results

Six patients underwent TU-LESS combined with upper abdominal laparotomy for DS successfully, and all of them achieved complete cytoreduction(R0). The average operative time was 417.50±103.09 mins, and the intraoperative bleeding was 566.67±273.25 ml, and the average postoperative hospital stay was 6.5±0.837 days. Only one patient developed postoperative lymphocyst. Six patients underwent follow-up chemotherapy as scheduled after DS.

Conclusion

TU-LESS approach combined with upper abdominal open surgery ensures tumor cell reduction and exhibits the characteristics of minimally invasive procedures, as well as, which impacts patient prognosis positively. This combined surgical approach is safe and feasible.

Key words: Transumbilical single-port laparoscopy, Ovarian cancer, Combined with upper abdominal laparotomy
表1 患者一般资料
病例 1 2 3 4 5 6
年龄(岁) 50 43 48 53 51 63
BMI( kg/m2) 28.0 24.6 19.9 25.3 21.8 22.1
初次治疗时的CA125(u/ml) 97.1 401.6 1488.5 7329 494.4 2497
IDS术前CA125(u/ml) － 7.7 23.8 87.7 12.5 25.6
初次治疗时Suidan评分(分) 2 11 9 8 6 5
NACT后Suidan评分(分) － 2 1 2 2 1
初次治疗时Fagotti评分(分) 4 － 8 8 10 8
NAC后Fagotti评分(分) － 4 2 4 4 2
诊断 卵巢高级别浆液性腺癌 卵巢高级别浆液性腺癌 卵巢低级别浆液性腺癌 卵巢高级别浆液性腺癌 卵巢高级别浆液性腺癌 卵巢高级别浆液性腺癌
分期 FIGO，ⅢC期 FIGO，ⅢC期 FIGO，ⅢC期 FIGO，ⅣB期 FIGO，ⅣA期 FIGO，ⅣA期
表2 患者手术相关资料
病例 1 2 3 4 5 6
手术时间(min) 315 560 465 496 350 320
术中出血(ml) 300 500 900 300 900 500
术后住院天数(d) 6 6 6 8 7 6
术中/术后并发症 无 无 淋巴囊肿 无 无 无
开腹手术探查较腹腔镜探查增加的病灶情况 回肠肠襻、肝肾间隙、肝胃间隙、脾肾间隙、小肠系膜根部等处见大小约0.5～1.5 cm的病转移病灶 肝肾隐窝见2 cm转移病灶，小肠、回肠肠襻之间、脾胃曲、肝胃曲分别见大小约0.5～1 cm的转移病灶 － － 结肠脾曲的病灶，大小约2 cm －
特殊手术情况 － 肠管表面病灶切除术后行肠修补术 － 部分膈肌切除术、心膈角转移淋巴结切除术 肠管表面病灶切除术后行肠修补术 －
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