Chalkiadakis G E, Lasithiotakis K G, Petrakis I, Kourousis C, Georgoulias V
Department of General Surgery, University General Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece.
Int J Gynecol Cancer. 2005 Nov-Dec;15(6):1115-9. doi: 10.1111/j.1525-1438.2005.00169.x.
Major liver involvement at the time of diagnosis is a rare event in patients with ovarian cancer, and the issue of major hepatectomy at the time of primary cytoreductive surgery is controversial. A 61-year-old woman was admitted to our hospital with nonspecific abdominal pain of 2-month duration and weight loss of 5 kg during the last semester. A computed tomography scan demonstrated bilateral ovarian masses, extending to the right iliac fossa, pressing the cecum-ascending colon. In the liver parenchyma, three cystic lesions were found of about 6-cm maximum diameter each, along with pelvic lymphadenopathy. There was no ascites. The diagnosis of advanced ovarian cancer was clinically suspected; the patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, right hemicolectomy, omentectomy, left lobectomy, deroofing, and draining of the cystic formation of the right liver lobe along with systematic pelvic and para-aortic lymphadenectomy. Systemic chemotherapy (six cycles of paclitaxel/carboplatin) was subsequently administered, and after 15 months of follow-up period, the patient is still in first remission and alive. Ovarian cancer with concomitant extensive right colon infiltration and hematogenous liver metastases can be successfully managed with aggressive surgical resection and postoperative chemotherapy in carefully selected patients.
对于卵巢癌患者而言，诊断时出现严重肝脏受累是一种罕见情况，并且在初次肿瘤细胞减灭术时进行大范围肝切除术这一问题存在争议。一名61岁女性因持续2个月的非特异性腹痛以及上一学期体重减轻5千克入住我院。计算机断层扫描显示双侧卵巢肿块，延伸至右髂窝，压迫盲肠-升结肠。在肝实质内，发现三个最大直径约6厘米的囊性病变，同时伴有盆腔淋巴结肿大。无腹水。临床怀疑为晚期卵巢癌；患者接受了全腹子宫切除术、双侧输卵管卵巢切除术、右半结肠切除术、大网膜切除术、左肝叶切除术、囊肿去顶术及右肝叶囊肿引流术，同时进行了系统性盆腔和腹主动脉旁淋巴结清扫术。随后给予全身化疗（六个周期的紫杉醇/卡铂），经过15个月的随访期，患者仍处于首次缓解期且存活。对于精心挑选的患者，伴有广泛右结肠浸润和血行性肝转移的卵巢癌可通过积极的手术切除及术后化疗成功治疗。
