卵巢移位对宫颈癌患者性激素和性生活质量的影响

Impact of Ovarian Transposition on Sexual Hormone and Quality of Sex Life of Patients with Cervical Carcinoma

目的探讨宫颈癌根治术中卵巢移位对患者性激素水平和性生活质量的影响。方法符合条件的宫颈癌根治术患者67例入组。根据治疗方法分组:对照组20例,未行卵巢移位及术后放化疗;研究组:A组23例行卵巢移位但术后未放化疗;B组24例行卵巢移位并辅助术后放化疗。采用性激素检测评价卵巢功能,采用问卷调查评价性生活质量,彩超评价卵巢形态。对比3组患者卵巢功能和性生活质量,评价卵巢移位的安全性和有效性。结果对照组和A组中各有2例卵巢功能衰退;B组24例中卵巢功能衰退22例,卵巢功能衰退率显著高于对照组。A组性激素水平均数与对照组相近;B组血清LH、FSH水平均数显著高于对照组,而E2、P水平均数显著低于对照组。A组术后性生活质量与对照组相近;B组术后性生活质量显著差于对照组。随访期内全组均无卵巢转移和卵巢良性疾病发生。结论宫颈癌术中卵巢移位是安全的;单纯卵巢移位不影响卵巢功能及性生活质量;卵巢移位后行放化疗者卵巢功能保全率低,性生活质量下降;改进手术方法和放疗设野可能有利于提高卵巢功能及性生活质量。

Objective This study was designed to explore the impact of ovarian transposition（OT） during radical hysterectomy（RH） on patients＇ sexual hormone and quality of sex life.Methods 67 patients underwent RH were enrolled in the study and divided into 3 groups： 20 patients underwent single RH without OT and postoperative chemoradiotherapy（CRT） were included in control group;23 patients underwent RH with OT but without CRT were divided into research group A;24 patients underwent RH,OT,and CRT were included in research group B.Ovarian function was evaluated by serum sexual hormone.A questionnaire was created to evaluate the quality of sex life.Colored ultrasonography was used to evaluate ovarian morphology.Ovarian function and quality of sex life were compared among these three groups to evaluate the safety and efficacy of OT.Results Ovarian withdrawal was observed in 2 cases in control group and group A,respectively.Ovarian withdrawal was observed in 22 out of 24 cases in group B.Ovarian withdrawal rate was significantly higher in group B than in control group.Average sexual hormone level was comparable between group A and control group.LH and FSH were higher in group B than in control group,whereas E2 and P were lower in group B than in control group.Quality of sex life was comparable between group A and control group,whereas quality of sex life was poorer in group B than in control group.No benign ovarian disorder was found in all patients during follow-up.Conclusion OT during RH is safe.Ovarian function and quality of sex life are not impacted by OT during RH.CRT after OT results in decrease of ovarian function and quality of sex life.Modification of surgical techniques and radiation design are expected to improve ovarian function and quality of sex life.