中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2013年
8期
595-601
,共7页
卢一艳%郭爱桃%刘爱军%石怀银
盧一豔%郭愛桃%劉愛軍%石懷銀
로일염%곽애도%류애군%석부은
假黏液瘤,腹膜%阑尾肿瘤%卵巢肿瘤%预后
假黏液瘤,腹膜%闌尾腫瘤%卵巢腫瘤%預後
가점액류,복막%란미종류%란소종류%예후
Pseudomyxoma,peritonei%Appendiceal neoplasms%Ovarian neoplasms%Prognosis
目的 探讨女性腹膜假黏液瘤的临床病理特征及预后影响因素.方法 回顾性分析解放军总医院1982年1月至2011年12月间收治的48例女性腹膜假黏液瘤患者的临床病理及随访资料,探讨腹膜假黏液瘤的临床病理特征.采用Kaplan-Meier法计算患者生存率,并采用log-rank检验、Cox风险比例模型分别对预后影响因素进行单因素及多因素分析.结果 (1)临床病理特征:48例患者的平均年龄为58.8岁(24 ～ 79岁)；症状:以腹胀、腹部不适为主；影像学检查:多数提示腹盆腔有非特异性占位性病变.治疗:48例患者均行剖腹探查及外科肿瘤细胞减灭术(CRS),其中肿瘤切除的完整性(CCR)分级为CCR-1者15例(31％)、CCR-2者24例(50％)、CCR-3者9例(19％)；6例(12％)患者术中行顺铂腹腔热灌注化疗(HIPEC),20例(42％)术后行不同方案的辅助化疗.病理类型:分为3型,即腹膜弥漫性黏液性腺瘤病、腹膜黏液性腺癌病以及伴有中间型形态的腹膜黏液性腺癌病,分别为22例(46％)、9例(19％)、17例(35％)；阑尾肿瘤类型:44例(92％)患者行阑尾切除术,其中阑尾肿瘤38例(包括低级别阑尾黏液性腺瘤20例、阑尾黏液性腺癌18例)、阑尾炎2例、不详4例,另4例(8％)未行阑尾切除术的患者,分别于首次手术后1、11、32和85个月出现腹腔肿瘤复发并发现阑尾黏液性肿瘤；实质脏器累及:卵巢累及者34例(71％,其中右侧累及者15例、双侧均累及者13例、左侧累及者6例),卵巢以外的其他实质脏器累及者10例(21％).(2)预后影响因素:48例患者中随访期内(随访1 ～ 479个月),11例死亡、31例存活、6例失访,患者总生存时间为1～312个月,中位总生存时间为99个月,3、5和10年总生存率分别为73.3％、68.0％和46.6％.单因素分析显示,年龄、病理类型及其他实质脏器累及与患者的预后有关(P＜0.05)；而手术次数、阑尾肿瘤类型、卵巢累及、CCR分级、术中HIPEC及术后辅助化疗均与患者的预后无关(P＞0.05).多因素分析显示,病理类型与年龄是影响患者预后的独立因素(P＜0.05).结论 腹膜假黏液瘤的临床表现无特异性,治疗宜行CRS联合HIPEC,并应常规探查双侧卵巢、行阑尾切除术.腹膜假黏液瘤的10年总生存率低,年龄、病理类型及卵巢以外的其他实质脏器累及与患者预后相关,且病理类型和年龄为影响患者预后的独立因素.
目的 探討女性腹膜假黏液瘤的臨床病理特徵及預後影響因素.方法 迴顧性分析解放軍總醫院1982年1月至2011年12月間收治的48例女性腹膜假黏液瘤患者的臨床病理及隨訪資料,探討腹膜假黏液瘤的臨床病理特徵.採用Kaplan-Meier法計算患者生存率,併採用log-rank檢驗、Cox風險比例模型分彆對預後影響因素進行單因素及多因素分析.結果 (1)臨床病理特徵:48例患者的平均年齡為58.8歲(24 ～ 79歲)；癥狀:以腹脹、腹部不適為主；影像學檢查:多數提示腹盆腔有非特異性佔位性病變.治療:48例患者均行剖腹探查及外科腫瘤細胞減滅術(CRS),其中腫瘤切除的完整性(CCR)分級為CCR-1者15例(31％)、CCR-2者24例(50％)、CCR-3者9例(19％)；6例(12％)患者術中行順鉑腹腔熱灌註化療(HIPEC),20例(42％)術後行不同方案的輔助化療.病理類型:分為3型,即腹膜瀰漫性黏液性腺瘤病、腹膜黏液性腺癌病以及伴有中間型形態的腹膜黏液性腺癌病,分彆為22例(46％)、9例(19％)、17例(35％)；闌尾腫瘤類型:44例(92％)患者行闌尾切除術,其中闌尾腫瘤38例(包括低級彆闌尾黏液性腺瘤20例、闌尾黏液性腺癌18例)、闌尾炎2例、不詳4例,另4例(8％)未行闌尾切除術的患者,分彆于首次手術後1、11、32和85箇月齣現腹腔腫瘤複髮併髮現闌尾黏液性腫瘤；實質髒器纍及:卵巢纍及者34例(71％,其中右側纍及者15例、雙側均纍及者13例、左側纍及者6例),卵巢以外的其他實質髒器纍及者10例(21％).(2)預後影響因素:48例患者中隨訪期內(隨訪1 ～ 479箇月),11例死亡、31例存活、6例失訪,患者總生存時間為1～312箇月,中位總生存時間為99箇月,3、5和10年總生存率分彆為73.3％、68.0％和46.6％.單因素分析顯示,年齡、病理類型及其他實質髒器纍及與患者的預後有關(P＜0.05)；而手術次數、闌尾腫瘤類型、卵巢纍及、CCR分級、術中HIPEC及術後輔助化療均與患者的預後無關(P＞0.05).多因素分析顯示,病理類型與年齡是影響患者預後的獨立因素(P＜0.05).結論 腹膜假黏液瘤的臨床錶現無特異性,治療宜行CRS聯閤HIPEC,併應常規探查雙側卵巢、行闌尾切除術.腹膜假黏液瘤的10年總生存率低,年齡、病理類型及卵巢以外的其他實質髒器纍及與患者預後相關,且病理類型和年齡為影響患者預後的獨立因素.
목적 탐토녀성복막가점액류적림상병리특정급예후영향인소.방법 회고성분석해방군총의원1982년1월지2011년12월간수치적48례녀성복막가점액류환자적림상병리급수방자료,탐토복막가점액류적림상병리특정.채용Kaplan-Meier법계산환자생존솔,병채용log-rank검험、Cox풍험비례모형분별대예후영향인소진행단인소급다인소분석.결과 (1)림상병리특정:48례환자적평균년령위58.8세(24 ～ 79세)；증상:이복창、복부불괄위주；영상학검사:다수제시복분강유비특이성점위성병변.치료:48례환자균행부복탐사급외과종류세포감멸술(CRS),기중종류절제적완정성(CCR)분급위CCR-1자15례(31％)、CCR-2자24례(50％)、CCR-3자9례(19％)；6례(12％)환자술중행순박복강열관주화료(HIPEC),20례(42％)술후행불동방안적보조화료.병리류형:분위3형,즉복막미만성점액성선류병、복막점액성선암병이급반유중간형형태적복막점액성선암병,분별위22례(46％)、9례(19％)、17례(35％)；란미종류류형:44례(92％)환자행란미절제술,기중란미종류38례(포괄저급별란미점액성선류20례、란미점액성선암18례)、란미염2례、불상4례,령4례(8％)미행란미절제술적환자,분별우수차수술후1、11、32화85개월출현복강종류복발병발현란미점액성종류；실질장기루급:란소루급자34례(71％,기중우측루급자15례、쌍측균루급자13례、좌측루급자6례),란소이외적기타실질장기루급자10례(21％).(2)예후영향인소:48례환자중수방기내(수방1 ～ 479개월),11례사망、31례존활、6례실방,환자총생존시간위1～312개월,중위총생존시간위99개월,3、5화10년총생존솔분별위73.3％、68.0％화46.6％.단인소분석현시,년령、병리류형급기타실질장기루급여환자적예후유관(P＜0.05)；이수술차수、란미종류류형、란소루급、CCR분급、술중HIPEC급술후보조화료균여환자적예후무관(P＞0.05).다인소분석현시,병리류형여년령시영향환자예후적독립인소(P＜0.05).결론 복막가점액류적림상표현무특이성,치료의행CRS연합HIPEC,병응상규탐사쌍측란소、행란미절제술.복막가점액류적10년총생존솔저,년령、병리류형급란소이외적기타실질장기루급여환자예후상관,차병리류형화년령위영향환자예후적독립인소.
Objective To investigate the clinic-pathological characteristics and prognosis of 48 female cases with peritoneal pseudomyxoma(PMP).Methods The clinicopathologic features and follow-up data of 48 female patients with PMP diagnosed in the General Hospital of People's Liberation Army from Jan.1982 to Dec.2011 were retrospectively reviewed.The relationship between clinic-pathological characteristics and prognosis were analyzed using log-rank test and Cox proportional hazards model.Results (1) Clinicopathologic features:the mean age of the 48 cases was 58.8 years (range from 24 to 79 years).Symptoms:abdominal distention and abdominal discomfort were the main symptoms.Imaging examinations showed nonspecific abdominal and pelvic lesions in most cases.Treatment:all the 48 patients underwentlaparotomy and cytoreductive surgery (CRS),in which 15 (31％) patients with completeness of the cancer resection (CCR)-1,24(50％) cases with CCR-2,and CCR-3 in 9(19％) cases.Six (12％) cases were treated by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin,20 (42％) patients were treated with different options postoperative adjuvant chemotherapy.Pathological types:the cases were histologically classified into 3 subcategories:disseminated peritoneal adenomucinosis (DPAM),peritoneal mucinous carcinomatosis (PMCA),and PMCA with intermediate or discordant features (PMCA-I/D),which were 22 (46％) cases,9 (19％) cases and 17 (35％) cases,respectively.Appendiceal tumors:44(92％) cases underwent appendectomy,in which 38 cases presented appendiceal tumors (including 20 cases of low-grade appendiceal mucinous adenoma and 18 cases of appendiceal mucinous adenocarcinoma),2 cases were diagnosed as appendicitis,4 cases with unknown pathologic diagnosis.And the other 4(8％) cases,who didn't undergo appendectomy at the first operation,presented peritoneal tumor recurrence and appendiceal mucinous tumors 1,11,32 and 85 months after surgery,respectively.Parenchymal organs involved:ovarian involving was happened in 34 (71％)patients including 15 cases with the right ovary involving,13 cases in both sides,and 6 cases involving the left side.The other parenchymal organs in 10(21％) cases.(2) Prognostic factors:11 patients died,31 survived and 6 cases were lost to follow-up.The mean survival time was 99 months(ranged from 1 to 312 months).The 3-year,5-year and 10-year survival rates were 73.3％,68.0％ and 46.6％,respectively.Univariate statistical analysis showed that age,pathological type and parenchymal involvement were significantly relationship with the survival time (all P ＜ 0.05).But the operation times,appendiceal tumor type,ovarian involvement,CCR,intraperitoneal HIPEC and post-operative adjuvant chemotherapy were not significantly correlate with survival time (all P ＞ 0.05).Multivariate analysis showed that age and pathologic type were independent prognostic factors (P ＜ 0.05).Conclusions No specific clinical features presented in PMP.CRS with HIPEC should the recommended treatment.Both ovaries exploration and appendectomy should be carried out routinely in CRS.The 10-year overall survival of PMP is low.Age,pathological type and parenchymal organs involvement other than ovarian are correlated with the prognosis.And the pathological type and age are independent prognostic factors of PMP.
