Sugarbaker Paul H
Program in Peritoneal Surface Malignancies, MedStar Washington Hospital Center, Washington, DC, USA.
Int J Surg Case Rep. 2019;62:5-8. doi: 10.1016/j.ijscr.2019.07.024. Epub 2019 Jul 19.
Cancer surgery has as its goal complete clearance and absolute containment of the malignant disease as it is being resected. Any aspect of the procedure which allows the escapes of malignant cells may result in disease recurrence.
The patient presented to an emergency room with left-sided abdominal pain. Pelvic sonogram suggested the diagnosis of a ruptured left ovarian cyst. A uterine biopsy showed high grade serous carcinoma. Definitive treatment of the primary ovarian cancer wasen bloc laparoscopic resection of her uterus, Fallopian tube and ovaries.
CT showed port site recurrence in both right and left upper abdominal trochar sites. The right-sided port site recurrence was through the fascia just lateral to the right rectus muscle and was small. A much larger port site metastases was present at the right trochar site that was through the left rectus muscle.
The incidence of midline and lateral port site recurrence after laparoscopy for diagnosis or resection of ovarian cancer has not been determined. Limitation of trochar sites to the midline may reduce the extent of abdominal wall disease spread.
癌症手术的目标是在切除恶性疾病时实现完全清除并绝对控制该疾病。手术过程中任何允许恶性细胞逸出的方面都可能导致疾病复发。
患者因左侧腹痛就诊于急诊室。盆腔超声检查提示左侧卵巢囊肿破裂。子宫活检显示高级别浆液性癌。原发性卵巢癌的确定性治疗是通过腹腔镜整块切除她的子宫、输卵管和卵巢。
CT显示右上腹和左上腹穿刺部位均有穿刺部位复发。右侧穿刺部位复发位于右直肌外侧的筋膜处，范围较小。左侧穿刺部位有一个大得多的穿刺部位转移灶，穿过左直肌。
腹腔镜诊断或切除卵巢癌后中线和外侧穿刺部位复发的发生率尚未确定。将穿刺部位限制在中线可能会减少腹壁疾病的扩散范围。
