| BackgroundBorderline Ovarian Tumor(BOT)is a kind of ovarian low malignant potential tumor,which is located between benign and malignant tumors,which accounts for about 5% of all ovarian epithelial tumors and 15% of ovarian epithelial cancer.Histological types are divided into serous,mucous,and a few other types(endometrioid,mixed epithelial,very few transparent cells,and transitional cells(Brenner tumor),etc.).In terms of clinical characteristics and biological behavior,they are different from ovarian malignancies.They are characterized by insidious onset,early onset,low metastatic rate,and good prognosis.The onset age of BOT is early,most of the patients have not completed the reproductive function,and the period is early and the prognosis is good,so more and more clinicians and patients tend to choose to retain fertility surgery.However,it is still a major problem in clinical work that how to select the surgical methods and surgical approaches of BOT to better retain the patient's reproductive function and improve the rate of postoperative pregnancy.With the progress of medical technology and the extensive implementation of minimally invasive concept,laparoscopy is being carried out in more and more gynecologic operations compared with traditional laparotomy.Laparoscopy has the advantages of less trauma,less bleeding,quicker recovery and less adhesion.However,laparoscopy is a new technology in recent years,and there are still some limitations in the clinical practice of patients with larger pelvic masses or pelvic and abdominal adhesions.Therefore,there are still some controversies in the treatment of early borderline ovarian tumors.ObjectiveTo discuss the clinical characteristics of the early ovarian borderline tumor,the operation mode of different fertility preserving function and the effect of different surgical approaches on the postoperative pregnancy.Objective to understand the clinical efficacy and value of laparoscopy in fertility preserving surgery for early borderline ovarian tumors,so as to provide guidance for further treatment.MethodsIn the period from December 2010 to December 2015,the diagnosis and treatment in the First Affiliated Hospital of Zhengzhou University,through the routine postoperative pathology confirmed 88 cases of early ovarian borderline tumors(stage I,excluded from other malignant tumors)parallel retained fertility function surgery as the research object,and the 88 all of the patients included in this study.Patients were divided into laparoscopic group and traditional laparotomy group according to different surgical approaches.Clinical data were recorded,and patients were followed up regularly.All patients were followed up by outpatient service or telephone until 2 years after operation.Analysis of clinical manifestations and signs of patients,ultrasound examination before operation,the CT(Computed Tomography CT),MRI(Magnetic Resonance imaging),tumor markers and other auxiliary examination of the disease diagnosis significance,analysis of different surgical approaches(laparoscopic and traditional open surgery),on the outcome of pregnancy after operation.Objective to discuss the difference of the pregnancy rate between laparoscopic and traditional open surgery in early borderline ovarian tumors,and to clarify the clinical value of laparoscopic surgery.Statistical analysis of the clinical data were analyzed using SPSS21.0 statistical software,numerical variables as mean standard deviation(SD),using t test for statistical analysis,the classification variable rate said,and the chi square test was used for statistical analysis,P < 0.05,the difference was statistically significant.ResultsIn the 88 cases of early ovarian borderline tumors,the youngest aged 13 years old,the maximum age of 40 years,the average age of 28.65 + 6.60 years.There were 50 cases of serous tumor,35 cases of mucinous tumor,3 cases of other rare types(endometrioid tumor,1 cases,mucinous tumor of 1 cases,1 cases of Brenner tumor),tumor stage: 58 cases in IA stage,15 cases in IB stage,15 cases in IC stage.Symptoms: 30 cases showed abdominal pain,abdominal distension and abdominal circumference increase,and 5 cases had acute abdominal pain due to complications such as tumor rupture or pedicle torsion.40 patients had no obvious symptoms,and pelvic masses were found by routine or accidental examination.8 cases showed abnormal urine frequency,urination,constipation,and other 10 cases were found by other systemic lesions.Auxiliary examination: ultrasound showed that BOT was mainly cystic and cystic,with internal papillae but no complex signals,and partial multilocular cysts.The sensitivity of CT and MRI to the diagnosis of BOT was poor,but it could be suggestive of distant metastasis and peripheral invasion.The positive rates of tumor markers in different types of borderline ovarian tumors are also different.Among them,the positive rates of CA125,CA199 and CEA are higher.For serous borderline tumors,CA125 is highly sensitive,while CA199 and CEA are mainly increased in mucinous borderline tumors.There was a positive correlation between the increase of tumor markers and the stage of borderline tumors.Operation: laparoscopic operation in 53 cases and abdominal operation in 35 cases(2 cases in laparoscopy converted to laparotomy).Different surgical methods,46 cases with unilateral andnextectomy patients(28 cases of laparoscopic and open cholecystectomy in 18 cases),unilateral cystectomy in 5 cases of patients(3 cases of laparoscopic and open cholecystectomy in 2 cases),using one side accessory resection + stripping operation in 22 cases of patients with contralateral ovarian cyst(11 cases of laparoscopic and laparotomy in 11 cases),with bilateral ovarian cyst in 15 cases of patients(11 cases of laparoscopic and open cholecystectomy in 4 cases).In all patients,74 cases of frozen ovarian tumors were reported as ovarian borderline tumors.In 9 cases,there were no clear reports of borderline tumors during the operation,and 5 cases were operated on emergency surgery.The first operation only retained the reproductive function and did not perform the staging operation.When the routine pathological results were proved to be borderline tumor,8 of them had twice staging operations to retain their fertility.6 patients requested temporary observation and refused two operations(4 cases of laparoscopy,2 laparotomy,no statistically significant difference).For mucous tumors,the appendix was excised at the same time.All the patients did not clear the lymph nodes,and the chemotherapy was not performed after the operation.Follow-up: During the 2 years follow-up period,There were 30 pregnancies(34.1%)after operation.18 of the patients in the laparoscopic group had successful pregnancy.12 of the laparotomy group had successful pregnancy.For unilateral tumors,the rate of pregnancy is higher than that of the latter,and the difference is statistically significant(P<0.05).For bilateral ovarian tumors,there is no statistically significant difference in pregnancy rate between bilateral ovarian cystectomy and unilateral annexectomy plus contralateral ovarian cystectomy(P>0.05).For tumor volume,the volume of borderline tumors in the open group was significantly larger than that in the laparoscopic surgery group,the difference was statistically significant(P<0.05),and the risk of cyst rupture during laparoscopic ovarian tumor removal was higher than that of laparotomy.But in the operation time,intraoperative blood loss,postoperative analgesic use,anal exhaust time,hospitalization time,complications,incision healing,laparoscopic pelvic infection has obvious advantages,and after laparoscopic group and laparotomy in patients with pregnancy rate of the difference was not statistically significant(P>0.05).Conclusion1.The onset age of BOT is very early.Most of them are women in childbearing age,and their growth is slow and their prognosis is good.Fertility preserving surgery is feasible in early BOT patients.2.The onset of BOT is occult,and preoperative diagnosis is difficult.Combined imaging and tumor markers can improve the accuracy of preoperative diagnosis,but the diagnosis still needs postoperative pathology.Intraoperative rapid frozen section plays a guiding role in the operation mode.3.Compared with laparotomy,there was no significant difference in pregnancy rate between the two groups after laparoscopy and laparotomy.Therefore,laparoscopic surgery is safe and feasible in patients with early borderline ovarian tumors requiring fertility preservation.4.Laparoscopy has the advantages of small trauma,less bleeding in the operation,quick recovery and less adhesion.With the development of laparoscopy,more and more BOT patients and clinicians who are required to retain fertility are inclined to choose laparoscopic surgery.However,due to the increase in the risk of rupture of ovarian cysts in laparoscopic surgery,indications should be carefully chosen. |
PDF Full Text Request