摘要
目的:评价腹腔镜在附件包块治疗中的价值及安全性。方法:回顾分析2000年1月至2003年12月北京协和医院术前诊断为良性附件包块2083例的腹腔镜手术治疗情况。患者平均33.4±8.9岁,绝经后妇女占1.8%。术中怀疑卵巢恶性肿瘤者送冰冻病理检查。计算腹腔镜术中诊断卵巢恶性肿瘤的敏感性(SEN)、特异性(SPE)、阳性预测值(PPV)及阴性预测值(NPV)。结果:2 083例患者中,2 067例为良性肿瘤,16例(0.77%)患者为卵巢交界性肿瘤(LMP)或卵巢癌,其中14例LMP及卵巢癌在术中确诊,2例卵巢癌术后确诊。55例(2.6%)患者术中可疑恶性送冰冻病理检查,检查结果为良性肿瘤41例(74.5%),LMP 8例(14.5%),卵巢癌6例(10.9%)。术后病理结果:良性肿瘤41例(74.5%),LMP 7例(12.7%),卵巢癌7例(12.7%)。术中冰冻与术后病理的符合率为98.2%。腹腔镜诊断卵巢恶性肿瘤的SEN为87.5%、SPE为98%、PPV为25.5%、NPV为99.9%。卵巢良性肿瘤2 067例,均进行了卵巢囊肿剔除术、附件切除术等。无中转开腹或围手术期并发症。16例LMP或卵巢癌患者中,7例行腹腔镜手术包括3例腹腔镜分期手术。16例患者术后平均随诊17.3月。1例LMP一侧附件切除术后4年对侧卵巢出现交界性肿瘤,行腹腔镜囊肿剔除术,其余病例均无复发征象。结论:腹腔镜可作为术前诊断为良性的附件包块的首选手术方式,术中意外发现卵巢LMP或者恶性肿瘤的机会较低。对可疑恶性的卵巢肿瘤,术中应进行冰冻病理检查。
Objective：To estimate the feasibility and safety of laparoscopic management of adnexal masses at low risk for malignancy. Methods：A total of 2 083 patients with benign adnexal mass were treated with laparoscopy from January 2000 to December 2003 at Peking Union Medical College Hospital （PUMCH）. Their clinical data were reviewed retrospectively. The mean age of the patients was 33.4 ± 8.9 years, 1. 8% of them were postmenopausal women. All the unexpected intracystic vegetations were sent for frozen section intraoperatively. The sensitivity（SEN）, specificity（SPE）, positive predictive value（ PPV ）, and negative predictive value（NPV） of laparoscopic diagnosis for low malignant potential（LMP） tumor or ovarian malignancy were calculated. Results：Of the 2083 patients ,2067 had benign tumors and 16 had LMP or invasive tumors （0.77%）. Among the 16 LMP or invasive tumors, 14 were diagnosed histologically intraoperatively and 2 postoperatively. Fifty-five （ 2.6% ） of the 2083 patients were found to have unexpected intracystic vegetations and frozen section evaluation was performed. Frozen section diagnose were benign in 41 （ 74. 5% ） patients, LIMP tumors in 8 （14. 5% ） and invasive ovarian cancers （stage Ic） in 6（ 10.9% ） patients. Final pathologieal diagnosis cancei＇8 （ pathology were benign in 41 （74.5%）, LMP tumors in 7 （ 12.7% ） and focal invasive ovarian stage Ic） in 7 （12.7%） cases. Frozen section diagnosis was concordant with the final in all but one patient who had a malignant tumor that was initially reported as LMP by py achieved 87.5% sensitivity,98% specificity,25.5% positive predictive value,99.9% negative predictive value in the diagnosis of ovarian malignancies. The 2067 cases with benign adnexal masses underwent was no conversion to laparoscopic management successfully. There peri-operative complications. Of the 16 patients with LMP or invasive ovarian cancer, seven underwent laparoscopic surgery including three immedi ate staging py. The mean follow-up was 17.3 months for patients with LMP or invasive ovrian cancer. One patient developed a recurrent LMP tumor in the contra-lateral ovary 36 months after laparoscopic salpingo-oophorectomy and underwent subsequent laparoscopic cystectomy, the others had no evidence of recurrent disease during follow up. Conclusion： With accurate preoperative selection, the rate of unexpected LMP or invasive ovarian malignancies is low at laparoscopy. Frozen section should be performed on all suspicious ovarian tumor. Laparoscop- ic management of ovarian tumors with low risk for malignancy is fesible and safe.
出处
《现代妇产科进展》
CSCD
北大核心
2006年第3期173-176,共4页
Progress in Obstetrics and Gynecology
