年轻宫颈癌患者卵巢功能保护的临床研究

Clinical Study of Preserving Ovarian Function in Young Patients with Cervical Carcinoma

目的探讨年轻宫颈癌患者保留卵巢适应征范围及提高保留卵巢功能的方法。方法58例45岁以下宫颈癌患者实施了卵巢移位术,其中53例在根治术同时行卵巢移位术,包括6例宫颈腺癌病例及12例术前行髂内动脉介入化疗病例。术后辅助放疗16例。5例在根治性放疗前行单纯卵巢移位术。通过血清性激素水平的测定及随访性生活状况等评估术后卵巢功能。结果58例卵巢移位术前术后血清性激素水平无统计学差别(P>0.05)。卵巢移位术后放疗组雌、孕激素水平虽较未放疗组低(P<0.05),但仍显著高于根治性放疗组(P<0.05)。随访中,无1例因卵巢转移复发。结论卵巢移位术是保留年轻宫颈癌患者卵巢功能安全有效的方法。恰当选择宫颈腺癌病例及通过新辅助化疗使部分中、晚期患者保留卵巢成为可能,尽可能的将卵巢移至远离放射野是提高保留卵巢功能的主要方法。

Objective To investigate the indications of ovarian function preservation and the methods to improve the ovarian function in young patients with cervical carcinoma. Methods 58 patients with cervical carcinoma under the age of 45 years underwent ovary transposition. 53 received ovary transposition at the time of radical hysterectomy, including 6 cases of adenocareinoma and 12 cases of iliae arterial interventional chemotherapy. 16 patients received postoperation radiotherapy. Five patients received pure ovary transposition before radical radiotherapy. Ovary function was evaluated by assaying the levels of serum E2 ,P,T,FSH ,LH and following-up the sexual situation. Results The serum hormonal levels had no difference before and after operation （ P 〉 0.05 ）. The levels of estradiol and progesterone in postoperation radiotherapy group were lower than that in the no radiotherapy group （P 〈 0. 05 ）, but were significantly higher than that in the radical radiotherapy group （ P 〈 0.05 ）. No ovary metastasis developed during the following-up period. Conclusion Ovary transposition is a safe and effective method of preserving ovarian function in young patients with cervical can^er. Ovary function could be safely preserved in some properly chosen patients with cervical adenocarcinoma. Preoperative neoadjuvant chemotherapy should be used in some advanced cases. Transfer the ovary/ ovaries outside the irradiation fields is the most important in the radiotherapy cases.