妇科恶性肿瘤患者的腹腔镜穿刺孔转移

Laparoscopic port-site metastases in patients with gynecological malignancies.

作者信息

Ramirez P T, Frumovitz M, Wolf J K, Levenback C

机构信息

Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.

出版信息

Int J Gynecol Cancer. 2004 Nov-Dec;14(6):1070-7. doi: 10.1111/j.1048-891X.2004.14604.x.

DOI:10.1111/j.1048-891X.2004.14604.x

PMID:15571612

Abstract

OBJECTIVE

The purpose of this study is to review all reported cases of laparoscopic port-site metastases in patients with gynecological malignancies. Potential etiologies as well as options for prevention are discussed.

METHODS

We searched the Medline database for English-language articles presenting raw data on laparoscopic port-site metastases in patients with gynecological malignancies.

RESULTS

We found 31 articles describing port-site metastases in 58 patients. Forty patients had low malignant potential (seven patients) or invasive ovarian carcinoma (33 patients). The median age of these patients was 50 years (range: 22-79), and 83% had advanced (stage III or IV) disease. Seventy-one percent of the patients (24 of 34) had ascites, and 97% (29 of 30) had carcinomatosis. Seventy-five percent of the laparoscopic procedures in this group were performed for diagnosis. Median time to diagnosis of port-site metastases was 17 days (range: 4-730). Seventy-one percent of port-site recurrences (15 of 21) were isolated to a tissue-manipulating port. Twelve patients had port-site metastases after laparoscopy for cervical cancer. The median age was 44 years (range: 31-74). Eighty percent of cases were squamous cell carcinoma. In 75% of the patients, laparoscopy was performed for therapeutic purposes. The median time to diagnosis of port-site metastases was 5 months (range: 1.5-19). Four patients had port-site metastases after laparoscopy for uterine cancer. The median age was 63 years (range: 56-72). The median time to diagnosis of metastases was 13.5 months (range: 6-21). Half of the recurrences were in the tissue-manipulating port. Port-site metastases after laparoscopy were reported for one patient each with a diagnosis of fallopian tube carcinoma and vaginal carcinoma.

CONCLUSIONS

Laparoscopic port-site metastases are a potential complication of laparoscopy in patients with gynecological malignancies, even in patients with early-stage disease.

摘要

目的

本研究旨在回顾所有已报道的妇科恶性肿瘤患者腹腔镜穿刺孔转移病例。探讨潜在病因及预防措施。

方法

我们在Medline数据库中检索了呈现妇科恶性肿瘤患者腹腔镜穿刺孔转移原始数据的英文文章。

结果

我们发现31篇文章描述了58例患者的穿刺孔转移情况。40例患者患有低恶性潜能（7例）或浸润性卵巢癌（33例）。这些患者的中位年龄为50岁（范围：22 - 79岁），83%患有晚期（III期或IV期）疾病。71%的患者（34例中的24例）有腹水，97%（30例中的29例）有癌性腹膜炎。该组中75%的腹腔镜手术是为了诊断。穿刺孔转移的中位诊断时间为17天（范围：4 - 730天）。71%的穿刺孔复发（21例中的15例）局限于组织操作孔。12例宫颈癌患者腹腔镜检查后发生穿刺孔转移。中位年龄为44岁（范围：31 - 74岁）。80%的病例为鳞状细胞癌。75%的患者进行腹腔镜检查是为了治疗。穿刺孔转移的中位诊断时间为5个月（范围：1.5 - 19个月）。4例子宫内膜癌患者腹腔镜检查后发生穿刺孔转移。中位年龄为63岁（范围：56 - 72岁）。转移的中位诊断时间为13.5个月（范围：6 - 21个月）。一半的复发发生在组织操作孔。各有1例输卵管癌和阴道癌患者在腹腔镜检查后报告发生穿刺孔转移。