Tinelli Raffaele, Malzoni Mario, Cosentino Francesco, Perone Ciro, Tinelli Andrea, Malvasi Antonio, Cicinelli Ettore
Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy.
Fertil Steril. 2009 Aug;92(2):736-41. doi: 10.1016/j.fertnstert.2008.07.1716. Epub 2008 Sep 14.
To outline the most recent information regarding conservative laparoscopic surgery for young women with borderline ovarian tumors.
Review article.
Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy.
PATIENT(S): Young women with low-stage borderline ovarian tumors who wish to preserve their fertility.
INTERVENTION(S): Conservative laparoscopic surgery with unilateral salpingo-oophorectomy or cystectomy.
MAIN OUTCOME MEASURE(S): Recurrence rate and outcomes.
RESULT(S): Laparoscopic cystectomy may have more chance of preserving a woman's fertility compared with adnexectomy because of the removal of less ovarian tissue. Its greatest danger is the risk of inadvertently leaving behind some malignant cells. Therefore, this procedure should be reserved for patients with previous unilateral salpingo-oophorectomy or when bilateral lesions are present to preserve at least some ovarian tissue.
CONCLUSION(S): When borderline ovarian tumors are identified at surgery by intraoperative histology, the recommended conservative treatment should be laparoscopic salpingo-oophorectomy. Recurrence can be noted after this type of treatment, but the cases of recurrent disease can be detected with close follow-up and treated accordingly. For these reasons, careful selection of candidates for this kind of treatment is, of course, necessary and close follow-up is required. If these restrictions are rigorously applied, then fertility-sparing surgery may be considered a safe option for this pathology, but all laparoscopic procedures should be reserved for oncologic surgeons trained in extensive laparoscopic procedures.
概述有关年轻女性交界性卵巢肿瘤保守性腹腔镜手术的最新信息。
综述文章。
意大利阿韦利诺马尔佐尼医疗中心高级妇科内镜中心。
希望保留生育能力的低分期交界性卵巢肿瘤年轻女性。
行单侧输卵管卵巢切除术或囊肿切除术的保守性腹腔镜手术。
复发率及手术结果。
与附件切除术相比，腹腔镜囊肿切除术切除的卵巢组织较少，因而更有可能保留女性的生育能力。其最大风险是无意中遗留一些恶性细胞。因此，该手术应仅用于既往已行单侧输卵管卵巢切除术的患者，或双侧病变时为保留至少部分卵巢组织的情况。
术中组织学检查在手术中确诊交界性卵巢肿瘤时，推荐的保守治疗应为腹腔镜输卵管卵巢切除术。此类治疗后可能会复发，但通过密切随访可发现复发病例并相应治疗。因此，当然有必要仔细挑选此类治疗的候选者并进行密切随访。如果严格遵循这些限制条件，那么保留生育功能手术对于这种病理情况可被视为一种安全选择，但所有腹腔镜手术都应仅由接受过广泛腹腔镜手术培训的肿瘤外科医生进行。
