放线菌素D、环磷酰胺、氨甲喋呤序贯化疗对卵巢功能的影响

Effects of ACM sequential chemotherapy on ovarian function in trophoblastic tumors

目的 探讨放线菌素－Ｄ、环磷酰胺、氨甲喋呤（ＡＣＭ）三联序贯方案治疗滋养细胞肿瘤时对卵巢功能的影响。方法观察了１７例滋养细胞肿瘤化疗前后月经、基础体温、血绒毛膜促性腺激素 亚单位（ ｈＣＧ）、雌二醇（Ｅ_２）、卵泡刺激素（ＦＳＨ）、黄体生成素（ＬＨ）的变化，并对部分病例做了卵巢活检进行形态学研究。结果 ＡＣＭ化疗对卵巢功能影响主要为月经量减少、黄体功能不全、Ｅ_２降低、促性腺激素增高。形态学观察表明卵巢各级卵泡数量减少但雌激素受体无改变。随着化疗的结束，上述功能多数可在一年内自行恢复正常。结论 ＡＣＭ化疗仅轻度抑制卵巢功能，主要影响卵巢内卵泡的生长与发育，说明对有生育要求的年轻患者首选ＡＣＭ化疗是合适的。

Objective To study the changes of ovarian function during and after ACM sequeneial chemothera- py on trophoblastic tumors. Methods 17 patients with. trophoblastic tumors , received totally 48 cycles of ACM chemotherapy. Of these, 7 underwent hysterntrtmy and focal ectomy and ovarian biopsy. Changes of menstruation and BBT were observed. -hCG, E2 FSH and LH were assayed and histologi- cal and immunohistochemical studies in ovaries biopsied were made. Results Amenorrhea and anovula- tory BBT were predominant at the onset of chemotherapy and high level of fLhCG. Following chemotherapy and decrease of p-hCG , menstruation recovered with less amount and BBT transformed into ovulatory types with shorter luteal phase. The E. level appeared to be lower and the FSH and LH level higher. The different kinds of follicles were decreased , but estrogen receptors unchanged. Follow- up showed that ovarian function of 12 of the 17 patients returned to normal in one year. Conclusion ACM chemotherapy suppresses ovarian function mildly and temporarily, Trophoblastic tumor also af- fects ovarian function . ACM chemotherapy seems to be suitable for young patients with trophoblastic eu- mors who desire child-bearing.