子宫颈癌患者保留卵巢术式探讨

Study of ovarian preservation operations for cervical cancer

２６例４１岁以前的宫颈癌患者行根治性治疗的同时，２例行卵巢移植术，２４例行卵巢移位术。利用Ｂ超、测定血清性激素水平等方法定期监测保留卵巢的功能。以探讨年轻早期子宫颈癌患者几种不同保留卵巢手术方式的效果。结果：接受卵巢移植术者，术后６个月卵巢开始周期性增大，术后９～１５个月恢复正常。１例随访１２ａ，卵巢功能正常。１例随访１０ａ，术后９ａ血清性激素值接近绝经期水平。卵巢移位者，未接受放射治疗的９例患者术后卵巢功能正常，卵巢功能持续５～８ａ，平均６２ａ。１５例术后１个月辅助放射治疗，放射治疗结束６个月后，大部分卵巢开始恢复排卵周期。辅助放疗组，９３３％（１４／１５）的患者保持卵巢功能，卵巢功能持续４～６ａ，平均４５ａ。辅助放疗组与未放疗组间卵巢功能持续时间差异有显著性（Ｐ＜００５）。放射治疗组与未接收放疗组５ａ生存率分别为９０６％和１００％（Ｐ＞００５）。结论：卵巢移位术是一种保留年轻宫颈癌患者卵巢功能的简便有效方法。

The ovarian transplants in 2 cases and ovarian transpositions in 24 cases were performed as primary radical hysterectomy was carried out. The preservative ovarian function was inspected by B scan ultrasonic and the serum concentration of sex hormon at regular intervals to evaluate the effection of two kinds of ovarian preservative operations in the young patients with early cervical cancer. Results revealed that the ovaries in transposition group had peridic changes.The ovarian function returned to normal 9 to 15 months after operations. The ovarian function was normal in 1 case in 12 year follow up. One case who received follow up for 10 years had the same level of sex hormon as that at postmenaupose for 9 postperational years. The ovarian function in transposition group was normal in 9 patients who were not treated with radiotherapy and their ovarian function continued between 5 and 8 years (coverage 6.24 years). The ovaries of 15 patients who were treated with radiotherapy in 1 month after operations returned to periodic ovulation 6 months after radiotherapy finished. The period of the ovarian function continuity in auxiliary radiotherapy group was significantly lower ( P <0.05) than that in the group without auxiliary radiotherapy. 93.3% patients had ovarian function in auxillary radiotherapy group. The 5 year survival rates in the radiotherapy and in no radiotherapy group were 90.6% and 100% respectively, and there was no significance ( P <0.05) between both groups. Conclusions: The ovarian transposition is a simple and effective operation preservating ovarian function and the radiotherapy has adverse effect on the preservative ovarian function.