CAJ | 학술논문

目的：分析卵巢交界性肿瘤行腹腔镜再分期手术的病例特点，探讨再分期手术的价值。方法我科1994年1月～2013年7月手术的卵巢交界性肿瘤129例中，行腹腔镜再分期手术6例。初次手术后诊断为Ⅰa期3例，Ⅰc期3例。6例均行腹腔镜全面分期手术。再分期手术包括全子宫切除（2例已生育者），一侧或双侧附件切除、大网膜切除、盆腔淋巴结清扫、腹主动脉旁淋巴结切除，3例同时行阑尾切除术。3例未生育者均行保留生育功能手术。结果腹腔镜再分期手术后病理阴性4例，阳性2例（1例为双侧卵巢肿瘤剔除术后双侧卵巢病灶残留，1例为初次手术后保留侧卵巢存在交界性病变）。6例淋巴结、大网膜或阑尾均为阴性。经腹腔镜再分期手术后分期及诊断未变5例，1例手术分期由Ⅰa期上升到Ⅰb期。无严重术中和术后并发症发生。随访10～32个月，（23．2±9．2）月，均无复发。结论腹腔镜卵巢交界性肿瘤再分期手术相对安全，也具有一定的意义。但对于初次手术肿瘤外观局限于卵巢的患者，再分期手术时盆腔和腹主动脉旁淋巴结清扫以及大网膜切除甚至阑尾切除的意义有待商榷。
목적：분석란소교계성종류행복강경재분기수술적병례특점，탐토재분기수술적개치。방법아과1994년1월～2013년7월수술적란소교계성종류129례중，행복강경재분기수술6례。초차수술후진단위Ⅰa기3례，Ⅰc기3례。6례균행복강경전면분기수술。재분기수술포괄전자궁절제（2례이생육자），일측혹쌍측부건절제、대망막절제、분강림파결청소、복주동맥방림파결절제，3례동시행란미절제술。3례미생육자균행보류생육공능수술。결과복강경재분기수술후병리음성4례，양성2례（1례위쌍측란소종류척제술후쌍측란소병조잔류，1례위초차수술후보류측란소존재교계성병변）。6례림파결、대망막혹란미균위음성。경복강경재분기수술후분기급진단미변5례，1례수술분기유Ⅰa기상승도Ⅰb기。무엄중술중화술후병발증발생。수방10～32개월，（23．2±9．2）월，균무복발。결론복강경란소교계성종류재분기수술상대안전，야구유일정적의의。단대우초차수술종류외관국한우란소적환자，재분기수술시분강화복주동맥방림파결청소이급대망막절제심지란미절제적의의유대상각。
Objective To evaluate the significance of laparoscopic restaging surgery for women with borderline ovarian tumors (BOT). Methods From January 1994 to July 2013, 129 patients were treated for BOT in our department, 6 of which underwent laparoscopic restaging surgery.Three patients were diagnosed as stage Ⅰa and three as stage Ⅰc after the primary surgery.The restaging surgery was performed via the laparoscopic approach in all the 6 patients. The restaging procedures included total hysterectomy, unilateral or bilateral salpingo-oophorectomy, omentectomy, pelvic lymphadenectomy, and para-aortic lymphadenectomy.A simultaneous appendectomy was conducted in 3 patients.Fertility-sparing surgery was employed in 3 childless patients. Results Among these 6 patients, 33.3% ( 2/6 ) pathological positive cases were found after the restaging surgery, including one case with bilateral persistent BOT lesions who had initially undergone bilateral cystectomy and another case with occult small BOT lesion in the preserved ovary after the primary surgery.No matastasis was found in all the specimens of omentum, lymph nodes and appendixes.One case was up-staged fromⅠa toⅠb after restaged.There were no serious intraoperative and postoperative complications.No recurrence occurred during the follow-up for 10-32 (23.2 ±9.2) months. Conclusions The results confirm the feasibility and significance of laparoscopic restaging surgery for women with borderline ovarian tumors.However, in those patients with lesions limited in the ovary in primary surgery, the implementation of lymphadenectomy, omentectomy, as well as appendectomy in the restaging surgery should be further discussed.