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卵巢癌手术治疗新进展
手术是卵巢癌的主要治疗措施。卵巢癌初次手术时应准确分期。早期行全子宫、双附件及部分大网膜切除术，盆腔及腹主动脉旁淋巴结清除术。晚期行理想的肿瘤细胞减灭术。如肿瘤持续或再发，则行二次减瘤术。对于初次手术未达到理想减瘤术或无法行手术者，应用间隔手术与化疗，终达到理想减瘤术标准。是否行二探术尚有争议。腹腔镜下不能行初次手术，但可于镜下行再分期术或二探术。早期卵巢癌年轻需保留生育者可行保守手术。
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卵巢癌大剂量化疗有待正确研究
Over the past decade numerous small phase Ⅰ/Ⅱ trials of high-dose chemotherapy for the treatment of ovarian cancer have been reported. The size of these studies, the wide variety of design, high toxicity, and lack of randomization have fueled the controversy on the use of such approaches. The trial reported in this issue of Gynecologic Oncology is no exception[1].In this study, nine patients with optimally debulked stage Ⅲ disease received three cycles of high-dose paclitaxel and carboplatin followed by one cycle of high-dose melphalan. The study end point was the second-look operation finding, and after only one patient (12.5%) achieved a pathological CR at second-look, the study was stopped early.过去十年,有许多Ⅰ/Ⅱ期卵巢癌应用大剂量化疗案例报告.这些研究的规模、众多不同的治疗方案、高的毒性以及缺乏随机性引起对于应用大剂量化疗的争议.在
杂志中的这一案例报道也不例外.在该研究中9例理想的肿瘤细胞减灭术后的Ⅲ期卵巢癌病人接受了3疗程大剂量紫杉醇和卡铂的化疗,之后又接受1疗程大剂量美法仑化疗.二探手术见到该研究终结果,在只有一例病人(12.5%)取得二探病理学完全缓解之后,该研究早早结束. -
剖宫产大出血并发DIC成功抢救1例
报告1例重度子痫前期合并胎盘植入病例,剖宫产术中大出血致DIC,行子宫全切术,术后并发腹腔积血及多脏器功能衰竭,行二次探查手术,经全院协同抢救成功.现分析总结为临床救治产后出血积累经验.
