[附件肿瘤的手术腹腔镜检查]

Steiner R A, Fehr M K, Wight E, Ioannidis K, Fink D, Haller U

Universitätsfrauenklinik, Zürich.

Schweiz Med Wochenschr. 1993 Dec 18;123(50):2357-62.

OBJECTIVES

The laparoscopic management of adnexal masses is still controversial. The main problems are preoperative diagnosis, operative technique and the possibility of compromising the prognosis by spillage of cancer cells when operating on a hitherto unrecognized early stage ovarian cancer. We report on our experience with minimal invasive surgery of adnexal masses.

METHOD

From June 1989 to July 1992, 375 patients underwent surgery for adnexal tumors at the University Hospital, Zurich. In 112 cases a laparoscopic operation was performed. The indications were unilateral or bilateral masses in the adnexal region with or without clinical symptoms. The preoperative workup included patient's history, clinical examinations, vaginal sonography and intraoperative evaluation of the tumor.

RESULTS

In 72% (83) of cases the organs were preserved by the laparoscopic procedure while in 28% (32) salpingo-oophorectomy, ovariectomy or salpingectomy was performed. The histopathologic findings included cystadenomas, cystadenofibromas, benign cystic teratomas, simple and functional cysts, mesothelium cysts, tubo-ovarian abscesses, endometriomas, and torqued tubes and/or ovaries. In no patient was a malignant process found. Only one postoperative complication was noted in a patient who had to be relaparoscoped due to adhesions to the operated ovary. One recurrence occurred in a hydrosalpinx.

CONCLUSIONS

Adnexal masses may safely be managed laparoscopically, with all the advantages of minimal invasive surgery, provided that strict diagnostic and therapeutic rules are observed.

目的

附件肿物的腹腔镜治疗仍存在争议。主要问题包括术前诊断、手术技术以及在处理此前未被识别的早期卵巢癌时癌细胞溢出对预后产生不良影响的可能性。我们报告了我们在附件肿物微创手术方面的经验。

方法

1989年6月至1992年7月，苏黎世大学医院有375例患者接受了附件肿瘤手术。其中112例行腹腔镜手术。适应证为附件区单侧或双侧肿物，有或无临床症状。术前检查包括患者病史、临床检查、阴道超声检查以及肿瘤的术中评估。

结果

72%（83例）患者通过腹腔镜手术保留了器官，28%（32例）患者进行了输卵管卵巢切除术、卵巢切除术或输卵管切除术。组织病理学检查结果包括囊腺瘤、囊腺纤维瘤、良性囊性畸胎瘤、单纯性囊肿和功能性囊肿、间皮囊肿、输卵管卵巢脓肿、子宫内膜异位症以及扭转的输卵管和/或卵巢。未发现患者有恶性病变。仅1例患者术后出现并发症，因与手术侧卵巢粘连需再次行腹腔镜检查。1例输卵管积水复发。