Michel G, Castaigne D, Morice P
Service de Chirurgie Générale Carcinologique, Institut Gustave-Roussy, Villejuif.
Ann Chir. 1997;51(10):1051-7.
Surgery is the essential element of staging and treatment of malignant ovarian tumours. Regardless of the stage, it must include peritoneal cytology, hysterectomy with bilateral adnexectomy, omentectomy, pelvic and lumbo-aortic lymphadenectomy, appendicectomy and multiple peritoneal biopsies. In stage I tumours, in young women desiring a subsequent pregnancy, preservation of the uterus and contralateral ovary can be proposed. In stages II, III and IV, the therapeutic strategy consists of primary surgery and systematic chemotherapy (6 cycles). Radical surgery is essential in these cases, as the size of the residual tumour at the end of operation constitutes the major prognostic factor. To optimize the quality of tumour debulking, the maximum of visible carcinomatous nodules must be resected with, if necessary, gastrointestinal resections. The value of second-look surgery, after 6 cycles of chemotherapy, is currently controversial: it is only indicated in the context of randomized trials. Borderline malignant ovarian tumours have a good prognosis regardless of their stage. Surgery can very often be conservative, particularly in young women. Adjuvant chemotherapy has been shown to be effective in these tumours. Many studies are underway to define the value of new cytostatic molecules and "interval" surgery (intercalated between several courses of chemotherapy).
手术是恶性卵巢肿瘤分期及治疗的关键要素。无论处于何阶段，手术都必须包括腹腔细胞学检查、子宫全切术加双侧附件切除术、大网膜切除术、盆腔及腹主动脉旁淋巴结清扫术、阑尾切除术以及多处腹膜活检。对于Ⅰ期肿瘤，若年轻女性有后续生育意愿，可考虑保留子宫及对侧卵巢。对于Ⅱ期、Ⅲ期和Ⅳ期肿瘤，治疗策略包括初次手术及系统性化疗（6个周期）。在这些病例中，根治性手术至关重要，因为手术结束时残余肿瘤的大小是主要的预后因素。为优化肿瘤减灭质量，必须切除最大数量的可见癌结节，必要时进行胃肠道切除。化疗6个周期后二次探查手术的价值目前存在争议：仅在随机试验的背景下才予以考虑。无论处于何阶段，交界性恶性卵巢肿瘤预后良好。手术通常可采取保守方式，尤其对于年轻女性。辅助化疗已被证明对这些肿瘤有效。目前正在进行许多研究以确定新的细胞抑制分子及“间隔”手术（在几个化疗疗程之间进行）的价值。
