Einenkel Jens, Ott Rudolf, Handzel Romy, Braumann Ulf-Dietrich, Horn Lars-Christian
Department of Obstetrics and Gynecology, Translational Centre for Regenerative Medicine, Leipzig University, Leipzig, Germany.
Int J Gynecol Cancer. 2009 Oct;19(7):1288-97. doi: 10.1111/IGC.0b013e3181a3a833.
The aim of this study was to determine the frequency of diaphragm involvement (DI) in cases of International Federation of Gynecology and Obstetrics (FIGO) stage IIIC and IV primary epithelial ovarian, fallopian tube, or peritoneal cancer; the frequency of use of different surgical techniques in managing diaphragm implants; and the procedure-associated morbidity.
A retrospective analysis of consecutive patients undergoing primary surgery by a single surgical team between January 2005 and June 2007 was accomplished. Patients with tumors of low malignant potential and nonepithelial histologic diagnosis and those who received neoadjuvant chemotherapy were excluded.
Thirty-three patients met the inclusion criteria. Diaphragm involvement was found in 91% of the cases. Whereas the left hemidiaphragm is never involved alone, the right side is significantly affected more extensively (P = 0.002) and frequently (alone, 20%; both sides, 80%). The frequency of use of procedures varies considerably in the literature, whereas full-thickness diaphragm resection (DR) had to be performed in 53% of our patients with DI. Diaphragm resection at the left hemidiaphragm and bilateral DRs are very rare in primary cases. A specific histopathologic examination of the DR preparation is desirable. A simple 4-tiered classification of the infiltration depth is proposed. The most frequent complication is serothorax, but a generous indication for intraoperative chest tube placement is solely recommended in cases of DR.
Surgical effort in achieving an optimum cytoreduction could be evaluated more precisely with parameters of DI and diaphragm-related treatment procedures. The usual quality criteria for ovarian cancer surgery, such as residual tumor state and morbidity, are more marked by subjectivity and inconsistent definitions.
本研究旨在确定国际妇产科联盟（FIGO）IIIC期和IV期原发性上皮性卵巢癌、输卵管癌或腹膜癌病例中膈肌受累（DI）的频率；处理膈肌种植灶时不同手术技术的使用频率；以及与手术相关的发病率。
对2005年1月至2007年6月期间由单一手术团队进行初次手术的连续患者进行回顾性分析。排除低恶性潜能肿瘤、非上皮组织学诊断的患者以及接受新辅助化疗的患者。
33例患者符合纳入标准。91%的病例发现有膈肌受累。左半膈肌从未单独受累，右侧受累范围更广（P = 0.002）且更频繁（单独受累20%；双侧受累80%）。文献中手术方法的使用频率差异很大，而在我们53%的DI患者中必须进行全层膈肌切除术（DR）。原发性病例中左半膈肌切除术和双侧DR非常罕见。DR标本需要进行特定的组织病理学检查。提出了一种简单的4级浸润深度分类法。最常见的并发症是胸腔积液，但仅在DR病例中建议术中大量放置胸管。
通过DI参数和与膈肌相关的治疗程序，可以更精确地评估实现最佳细胞减灭的手术努力。卵巢癌手术通常的质量标准，如残留肿瘤状态和发病率，主观性更强且定义不一致。
