吻合器膈肌切除术：晚期卵巢癌膈肌细胞减灭术的新方法。

Stapled diaphragm resection: A new approach to diaphragmatic cytoreductive surgery for advanced-stage ovarian cancer.

机构信息

Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion. Switzerland; Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland.

Department of General Surgery, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland; Department of Visceral Surgery, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2022 Dec;279:88-93. doi: 10.1016/j.ejogrb.2022.10.014. Epub 2022 Oct 21.

DOI:10.1016/j.ejogrb.2022.10.014

PMID:36283249

Abstract

OBJECTIVE

To evaluate a novel technique for diaphragmatic full-thickness resection (DFTR) using a vascular stapler to perform cytoreductive surgeries in patients with advanced ovarian cancer.

STUDY DESIGN

Single-center retrospective analysis of consecutive patients with advanced-stage ovarian cancer undergoing stapled diaphragmatic full-thickness resections (S-DFTRs) as part of cytoreductive surgeries between January 2018 and June 2022, according to the IDEAL recommendations.

RESULTS

Fifteen patients underwent cytoreductive surgeries with S-DFTRs. The median operative time was 300 (114-547) minutes. Cytoreduction was considered complete in all cases. All S-DFTRs were performed on the right diaphragm. Concomitant left diaphragmatic peritoneal stripping was performed in 5 cases (33.3%) and was associated with a conventional DFTR in 1 case (6.7%). Prophylactic intraoperative tube thoracostomy was never required. Four patients (26.7%) were admitted to the intensive care unit. Pleural effusion was observed in 9 patients (60.0%), and 4 (26.7%) required a postoperative pigtail catheter thoracostomy. Three patients (20.0%) required catheter placement on the right hemithorax (ipsilaterally to the S-DFTR) and 2 patients (13.3%) required catheters on the left hemithorax (contralaterally to the S-DFTR). Pneumothorax requiring tube thoracostomy was observed in 1 case (6.7%) on the left hemithorax (contralaterally to the S-DFTR). Pulmonary embolism and pneumonia were both observed once (6.7%). The median hospitalization length was 14 (5-36) days. During the follow-up, 6 patients (40.0%) had a recurrence, but none involved the pleura or the diaphragm. According to the IDEAL classification, this study could be ranked as stage 2a (development).

CONCLUSIONS

This technique appears to be a fast and safe method for performing diaphragmatic cytoreductive surgeries and could reduce postoperative complications.

摘要

目的

评估一种使用血管吻合器进行膈全层切除术（DFTR）的新技术，以在晚期卵巢癌患者中进行细胞减灭术。

研究设计

根据 IDEAL 建议，对 2018 年 1 月至 2022 年 6 月期间连续接受吻合器膈肌全层切除术（S-DFTR）作为细胞减灭术一部分的晚期卵巢癌患者进行单中心回顾性分析。

结果

15 例患者接受了 S-DFTR 细胞减灭术。中位手术时间为 300（114-547）分钟。所有病例均认为减瘤完全。所有 S-DFTR 均在右膈进行。5 例（33.3%）同时行左膈腹膜剥离，1 例（6.7%）行常规 DFTR。术中预防性胸腔引流管从未需要。4 例（26.7%）患者收入重症监护病房。9 例（60.0%）患者出现胸腔积液，4 例（26.7%）需要术后猪尾导管胸腔引流。3 例（20.0%）患者右侧胸腔（与 S-DFTR 同侧）需要置管，2 例（13.3%）患者左侧胸腔（与 S-DFTR 对侧）需要置管。左侧胸腔（与 S-DFTR 对侧）气胸需行胸腔引流管置管 1 例（6.7%）。肺栓塞和肺炎各发生 1 次（6.7%）。中位住院时间为 14（5-36）天。在随访期间，6 例（40.0%）患者复发，但均未累及胸膜或膈肌。根据 IDEAL 分类，本研究可归类为 2a 期（发展）。