卵巢癌的橫隔膜減積術

Diaphragmatic Surgery in Advanced Ovarian Cancer

文獻研究已證明，晚期卵巢癌患者在減積手術後如沒有殘餘腫瘤、或達到理想減積的標準，會有較長的生存時間。卵巢癌在腹腔中擴散常侵犯橫隔膜，而橫隔膜腫瘤的切除如有困難，便不能達成理想的減積。很多婦癌醫師認為，若能將橫隔膜病灶全部切除，患者能得到較好的後果。許多近期研究報告，若以剝削法、電燒灼、腹膜切除、或肌肉切除，來切除橫隔膜的病灶，使達成理想的減積術，結果使生存的時間較沒有做橫隔膜病灶切除者為長，因此，對卵巢癌的患者，橫隔膜的病灶應盡量切除。

There is a consensus of evidence in the literature indicating that no residual tumor or optimal debulking at completion of cytoreductive surgery for advanced ovarian cancer, results in a better survival. Diaphragm involvement is very common in the majority of women with abdominal dissemination of ovarian cancer. Generally, lesion in this location is difficult to manage and a common justification for not achieving maximal tumor cytoreduction. In recent years, several efforts have been made by gynecologic oncologists to underline the role of diaphragmatic debulking and its survival advantages in these patients. The studies have demonstrated that diaphragmatic implants can be resected with various surgery techniques, such as stripping, coagulation, peritonectomy or muscle resection. Surgical procedure to remove diaphragmatic tumor increase the rate of complete and optimal debulking and correlate with improved survival compared to patients optimally debulked without diaphragmatic surgery performed.