Gulo E I, Maksimov S Ia, Livshits M A, Shcherbakov A M
Prof. N.N. Petrov Research Institute of Oncology, Ministry of Health of the RF, St. Petersburg.
Vopr Onkol. 1998;44(2):205-10.
The data on 503 cases of ovarian malignancies were evaluated to work out indications for and clinical assessment of revision laparotomies. Second-look surgery was carried out in the following situations: (1) tumor elements found in the washings of the peritoneum in Douglas' space and high blood-serum levels of CA-125 (8 patients with stage I-II tumors, in clinical remission); (2) during remission, after 6-10 courses of polychemotherapy (13 patients with stage III-IV tumors); (3) during remission, after non-radical primary surgery (117); (4) suspected recurrence (144); (5) recurrence-free surgical pathology, e.g. ventral hernia, requiring laparotomy (22). Patients without repeated laparotomy (199) were in control. During remission, surveillance can be carried out using cytologic, ultrasound and immunoradiologic techniques since laparoscopy fails. The latter is useful, for diagnostic purposes, in case of discrepancy between clinical and ultrasound evidence as well as during monitoring in patients in clinical remission who show unfavorable levels of CA-125 and poor results of sonographic. Laparotomy is indicated prior to chemotherapy of inoperable tumors for morphologic verification of diagnosis. Indications for second-look operations can be significantly decreased considering the latest improvements in non-invasive monitoring technique. Laparoscopic examination can effectively serve the same purposes.
对503例卵巢恶性肿瘤的数据进行了评估，以确定再次剖腹手术的指征和临床评估。在以下情况下进行二次探查手术：（1）在Douglas腔腹膜冲洗液中发现肿瘤成分且血清CA-125水平升高（8例I-II期肿瘤患者，处于临床缓解期）；（2）在缓解期，经过6-10个疗程的多药化疗后（13例III-IV期肿瘤患者）；（3）在缓解期，在非根治性初次手术后（117例）；（4）怀疑复发（144例）；（5）无复发的手术病理情况，如腹疝，需要剖腹手术（22例）。未进行再次剖腹手术的患者（199例）作为对照。在缓解期，由于腹腔镜检查失败，可使用细胞学、超声和免疫放射学技术进行监测。对于临床和超声证据存在差异的情况，以及在临床缓解期CA-125水平不利且超声检查结果不佳的患者进行监测时，腹腔镜检查对于诊断目的是有用的。对于无法手术的肿瘤，在化疗前进行剖腹手术以进行形态学诊断验证。考虑到非侵入性监测技术的最新进展，二次探查手术的指征可显著减少。腹腔镜检查可有效地达到相同目的。
