交界性卵巢上皮性肿瘤保守性手术的预后与生育状况

Prognostic Factors and Fertility Outcomes of Borderline Ovarian Tumors after Conservative Surgery

目的评估采用保守性手术方式治疗交界性卵巢上皮性肿瘤(BOT)的预后及生育情况。方法回顾性分析北京协和医院1990年1月至2007年12月行保守性手术治疗的109例BOT患者的临床资料,其中Ⅰa及Ⅰb期34例(31.2%),Ⅰc期66例(60.6%),Ⅱ、Ⅲ、Ⅳ期分别为2(1.8%)、7(6.4%)、0例。结果 40例(36.7%)患者行全面分期手术,27例(24.8%)行肿瘤剔除术,42例(38.5%)行单侧附件切除术;开腹和腹腔镜手术分别为81例(74.3%)和28例(25.7%)。术后平均随访(60.3±42.5)个月,25例(22.9%)患者复发,复发间期平均为(36.1±31.9)个月;1例死亡。Logistic回归分析结果显示,肿瘤分期及是否行分期手术是肿瘤复发的相关因素。66例有生育要求者中有24例(36.4%)妊娠。结论 BOT的预后相对较好,对于有生育要求的患者应行保守性手术治疗以保留其生育功能。手术的彻底性与肿瘤复发相关,但范围较大的分期手术是否会造成术后不孕,仍需大样本研究证实。

Objective To evaluate the prognostic factors and fertility outcomes of borderline ovarian tumors（BOT）after conservative surgery.Methods The clinical data of 109 patients with BOT who were treated in Peking Union Medical College Hospital from January 1990 to December 2007 were retrospectively analyzed.According to the FIGO staging system,there were 34（31.2%）patients at StageⅠa andⅠb,66（60.6%）at StageⅠc,2（1.8%）at StageⅡ,and 7（6.4%）at stage Ⅲ.No patient was at Stage IV.Results Surgical treatment included comprehensive staging surgery（n=40,36.7%）,ovarian cystectomy（n=27,24.8%）,and unilateral salpingo-oovarectomy（n=42,38.5%）.The average follow-up period was（60.3±42.5）months.Relapse occurred in 25 patients（22.9%）,and the mean duration from therapy to recurrence was（36.1±31.9）months.Only one patient died of BOT.Multivariate analysis showed that surgery procedure and tumor stage were the independent prognostic factors affecting recurrence.Of 66 patients with the desire of fertility,24（36.4%）finally got pregnant.Conclusions Conservative surgery has comparativelygood prognosis and should be the first choice for younger patients with the desire of fertility.The high-risk factors should be evaluated before the initiation of treatment.