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卵巢癌肝膈间转移83例手术经验总结

The surgical treatment of ovarian cancer metastasis between liver and diaphragm:a report of 83 cases

摘要:

目的 探讨联合膈肌切除的卵巢癌肝膈间转移灶切除术的安全性和可行性.方法 回顾性分析2012年1月至2016年12月北京协和医院肝脏外科收治的83例(98例次)卵巢癌肝膈间转移患者的临床资料,患者年龄19~75岁.手术方式包括肝膈间转移灶剥除术(55例次)和联合膈肌切除术(43例次).收集患者的临床资料,对术中情况、术后并发症、病理学检查结果及随访情况进行分析.结果 83例患者中,15例接受了2次手术,68例接受1次手术.患者术后均未出现胸腔和肝膈间出血.转移灶剥除术病例中2例、联合膈肌切除术病例中1例术后出现呼吸困难、氧饱和度降低,经胸部CT检查发现右侧胸腔有中至大量积液,放置胸腔闭式引流后症状缓解.其他病例均恢复顺利.全部病例术后石蜡病理学检查结果均证实为卵巢癌转移.结论 联合膈肌切除的卵巢癌肝膈间转移灶切除术安全、可行.

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abstracts:

Objective To explore the safety and feasibility of associating diaphragm resection and liver-diaphragmatic metastasis lesions resection for patients with advanced ovarian cancer. Methods Retrospectively analysis 83 cases( 98 times) of advanced ovarian cancer with liver-diaphragmatic metastasis between January 2012 and December 2016 at Department of Liver Surgery,Peking Union Medical College Hospital. The patients were aged from 19 to 75 years. Surgical procedure included metastatic lesions resection (43 times) and stripping(55 times). Operation status,post-operative complications,pathology results and follow-up of the patients were analyzed. Results Fifteen patients received twice surgical treatment and 68 patients received one time surgical treatment. Postoperative hemorrhage in chest and between liver and diaphragm was not occurred in all cases. Dyspnea and low oxygen saturation were occurred in two cases of stripping patients and 1 case of metastatic lesions resection patients. Results of CT examination indicated that there was medium to large amount of ascites in right chests. The symptoms were relieved after placing thoracic closed drainage. Other patients were recovered smoothly. All patients were diagnosed as ovarian cancer by pathological examination. Conclusion Associating diaphragm resection is safe and feasible for liver-diaphragmatic metastasis lesions from ovarian cancer.

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