Secondary exploration of ovarian cancer
After ovarian malignant tumors undergo tumor resection or tumor depletion, although the prescribed course of chemotherapy, but there is no clear serum indicators and other detection methods to determine the presence or absence of tumor retention, there are still a small number of patients with CA125 and imaging findings. At the second exploration, the tumor was found to exist. Therefore, the second laparotomy should be used to objectively and correctly evaluate the efficacy of ovarian cancer patients, and the chemotherapy can be clearly guided to achieve rational drug use and reduce side effects. If no cancer is found after exploration, chemotherapy can be stopped. For example, in the second exploration, see the cancer lesions that were not found before surgery, indicating that the previously used chemotherapy regimen is ineffective or has developed resistance. Therefore, after removing the cancerous lesion as much as possible, it is necessary to consider changing the original treatment plan or adding radiation therapy. .Treatment of diseases: ovarian tumor ovarian cancer Indication
1. Patients who have complete remission after 6 to 8 courses of chemotherapy after ovarian cancer surgery are generally performed within 1 to 2 years after treatment.
2. Clinically, partial remission is needed. It is necessary to determine whether to continue chemotherapy, vaginal double diagnosis, isotope imaging, tumor markers, etc. can not determine whether there is recurrence.Preoperative preparation
1. Same as general abdominal surgery.
2. Long-term chemotherapy can cause damage to heart, liver, kidney and bone marrow, so the function should be checked again before surgery.
3. Have had a history of intestinal obstruction, and should prepare for the bowel before surgery.Surgical procedure
The original incision is opened or inserted through the right rectus abdominis incision.
2. Cytological examination
After entering the abdominal cavity, the pelvic and abdominal cavity is rinsed for the first time to recover the cytology. If there is ascites, it can be collected directly.
From top to bottom, carefully examine and touch the pelvic and abdominal organs from front to back, including the original surgical wound, omental stump, hepatobiliary, diaphragm, colon, appendix, small intestine, spleen, kidney, and peritoneal and retroperitoneal lymph nodes.
It includes the following parts: 1 primary tumor site and known metastatic site. 2 Any suspiciousities such as adhesions and surface irregularities were observed during the investigation. 3 peritoneal, pelvic hernia, paracolic sulcus, diaphragm, large intestine serosa and mesenteric adhesions. 4 retroperitoneal lymph nodes.
5. Excision of residual tumor
All visible tumors should be removed as much as possible, and the entire uterus, attachment, omentum or appendix should be removed as appropriate.
6. Guan abdomen
Rinse the abdominal cavity and close the abdomen.complication
Same as general open surgery.
As early as the early 1980s, laparoscopic examination was used to replace the traditional double laparotomy. Clinical data showed that patients can undergo laparoscopy 1 to 2 years after receiving regular chemotherapy, through endoscopy. The entire abdominal cavity can be carefully observed, and multiple biopsy can be performed in the intestinal serosa and paracolic sulcus, and the peritoneal lavage fluid is retained. It is found that 43% of the biopsy is positive, and 18% of the peritoneal lavage fluid has found cancer cells, so it is considered Although laparoscopic surgery can not completely replace transabdominal laparotomy, there are certain complications, but laparoscopic second exploration has shown more and more advantages in the follow-up after ovarian treatment.