目的 探讨早期卵巢癌腹腔镜全面分期手术的安全性及可行性. 方法 回顾性分析我院2008年6月～2010年10月腹腔镜探查术中冰冻病理报告为卵巢恶性肿瘤而立即进行腹腔镜全面分期手术病例的临床资料.盆腔淋巴清扫,漏斗韧带高位切断,凝切子宫血管,超声刀凝切双侧骶韧带、主韧带,下推直肠,暂不切断阴道.行大网膜、阑尾切除术.腹腔镜下环切阴道穹隆,从阴道取出子宫、附件、盆腔淋巴结、大网膜及阑尾.镜下缝合阴道残端及盆腔腹膜,不留引流管. 结果 所有手术均顺利完成,无中转开腹和术中、术后并发症,手术时间(230.1±36.0)min,术中出血量(103.2±13.5)ml,盆腹腔淋巴结(15.8±5.6)个,术后肛门排气时间(2.3±0.4)d,术后48 h拔出尿管,术后住院时间(14.7±4.0)d.病理类型:卵巢浆液性乳头状囊腺癌2例,卵巢黏液性囊腺癌2例,卵巢透明细胞腺癌1例.手术病理分期:Ⅰ期4例,Ⅱ期1例.随访8～24个月,(18.4±5.6)月,未发现复发,无腹壁穿刺口转移. 结论 早期卵巢癌腹腔镜全面分期手术安全可行,术后恢复较快,近期效果良好.%Objective To investigate the safety and feasibility of comprehensive laparoscopic staging on early-stage ovarian carcinoma. Methods From June 2008 to October 2010, 5 patients with early stage ovarian carcinoma underwent comprehensive laparoscopic staging in our hospital. The clinical pathology and follow-up data of the patients were analyzed retrospectively. The key surgical steps included a comprehensive exploration of the pelvic abdominal cavity, frozen section, and then comprehensive staging surgery of the ovarian cancer (pelvic lymph node dissection, and then cutting off the funnel ligament, condensating the uterine vessels, bilateral sacral ligament, and cardinal ligament with the harmonic scalpel, and pushing down the rectum, and finally removal of the vagina). We did the omental resection, removed the appendix, put the vaginal sleeve circumcision into the vagina,and finally removed the attachments, pelvic lymph nodes, omentum appendix and uterus from the vagina. After the procedure, the vaginal stump and pelvic peritoneum was sutured without leaving a drainage tube. Results All the procedures were completed successfully without conversion to laparotomy, no major intraoperative or postoperative complications occurred. The mean operation time was (230. I ±36. 0) min, and intraoperative blood loss was ( 103.2 ± !3.5) ml. A mean of 15.8 ±5.6 pelvic lymph nodes were removed during the procedure. The patients' gastrointestinal function recovered in (2.3 ±0.4) days after the surgery, and the urine catheter was removed in 48 hours. The mean postoperative hospital stay of the patients was (14.7 ±4.0) days. Postoperative pathological examination showed two cases of ovarian serous papillary adenocarcinoma, two cases of ovarian mucinous adenocarcinoma and one case of ovarian clear cell adenocarcinoma; and pathological staging showed four cases of stage I and 1 cases of stage 0 . The paitent were followed up for 8 -24 months with a mean of (18.4 ±5.6) months, during which no recurrence or metastasis to the puncture site was observed. Conclusion Comprehensive laparoscopic staging is safe and feasible for early-stage ovarian carcinoma with good short-term outcomes and quick postoperative recovery.
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