Institut Gustave Roussy, Villejuif, France.
J Am Coll Surg. 2010 Apr;210(4):509-14. doi: 10.1016/j.jamcollsurg.2010.01.011.
Surgical management of advanced-stage ovarian cancer (ASOC) can require diaphragmatic surgery (DS) to achieve complete cytoreduction. The aim of this study was to evaluate modalities and morbidities of DS at the time of initial surgery (INS) and interval debulking surgery (IDS; performed after neoadjuvant chemotherapy).
Retrospective review of patients undergoing (unilateral or bilateral) DS at the time of INS or IDS for ASOC.
Between 2005 and 2008, 63 patients were studied. Treatment of the diaphragm was unilateral in 31 patients and bilateral in 32 patients. DS was performed respectively at the time of INS in 22 patients (35%) and IDS in 41 (65%) patients. Complete cytoreductive surgery was achieved in 95% (21 of 22 in the INS group and 39 of 41 in the IDS group). Surgical procedures used during DS were (in the INS and IDS groups, respectively) stripping in 14 (64%) and 16 (39%), coagulation in 2 (9%) and 10 (24%), and both procedures in 6 (27%) and 15 (37%). An intraoperative chest tube was placed in 14% of patients in each group. Postoperative chest complications requiring treatment occurred in 6 cases: pulmonary embolism (3 cases), symptomatic pleural effusion requiring chest drainage (1 case), and pneumothorax necessitating chest drainage (2 cases).
Rate of overall morbidity related to DS was not statistically different in patients undergoing INS and IDS. Surgical treatment of this upper part of the abdomen is key to achieving complete cytoreductive surgery in ASOC.
晚期卵巢癌（ASOC）的外科治疗可能需要膈肌手术（DS）以实现完全减瘤。本研究旨在评估初始手术（INS）和间隔减瘤手术（IDS；在新辅助化疗后进行）时进行 DS 的方式和并发症。
对接受 ASOC 时 INS 或 IDS 单侧或双侧 DS 的患者进行回顾性研究。
在 2005 年至 2008 年间，共有 63 例患者接受了研究。31 例患者的膈肌治疗为单侧，32 例患者为双侧。DS 分别在 22 例患者的 INS 时（35%）和 41 例患者的 IDS 时（65%）进行。95%（INS 组 21 例和 IDS 组 39 例）的患者实现了完全减瘤手术。DS 术中使用的手术程序分别为（在 INS 和 IDS 组中）剥离术 14 例（64%）和 16 例（39%）、凝固术 2 例（9%）和 10 例（24%），以及这两种手术程序各 6 例（27%）和 15 例（37%）。每组各有 14%的患者术中放置了胸腔引流管。术后发生需要治疗的胸部并发症有 6 例：肺栓塞（3 例）、需要胸腔引流的症状性胸腔积液（1 例）、气胸需要胸腔引流（2 例）。
INS 和 IDS 患者的 DS 相关总发病率无统计学差异。腹部上半部分的这种手术治疗是 ASOC 实现完全减瘤的关键。
