化疗对年轻卵巢恶性肿瘤患者保留生育功能手术后卵巢功能的影响

The effect of chemotherapy on ovarian function in patient with ovarian carcinoma undergoing preservation operation

目的探讨保留生育功能手术的卵巢恶性肿瘤患者接受化疗对卵巢功能的影响。方法 1994年10月至2010年1月间保留生育功能手术的卵巢恶性肿瘤患者30例,分析化疗对其月经情况、性激素水平及生育情况的影响。并以同期因卵巢上皮交界性肿瘤行保留生育功能手术术后未接受化疗者28例为对照组。结果 30例保留生育功能手术后化疗的卵巢恶性肿瘤患者中,21例(70%)出现月经异常,其中12例(40%)发生停经,9例(30%)出现月经减少,停经出现在化疗后1～4个月[平均(2.17±0.8)个月]。发生停经的12例患者化疗结束后均恢复月经;月经恢复时间在化疗结束后2～7个月[平均(3.42±1.38)个月]。采用化疗方案为BEP方案(16例)、PVB方案(5例)、PT方案(3例)和PC方案(6例),其发生停经的例数分别为6例、1例、0例和5例。对照组28例中,术后2例(7.14%)出现月经减少,均未出现停经。与化疗组比较,差异有统计学意义(P<0.05)。化疗组5例停经患者停经期间黄体生成素和卵泡刺激素均明显升高,雌二醇明显降低。对照组6例术后血清性激素与术前比较,均无明显变化。化疗组30例患者中,12例有生育计划,其中4例已成功妊娠分娩;对照组14例有生育要求患者,8例成功妊娠分娩,子代均健康无畸形。化疗组中,2例死亡,28例无瘤生存;对照组全部无瘤生存。结论年轻妇女卵巢恶性肿瘤行保留生育功能的手术后化疗,可发生卵巢功能损害;其主要表现为停经或月经减少,血清促性腺激素水平升高,雌激素水平降低。化疗导致的停经是可逆的。化疗对患者的生育功能可能有一定影响,但对子代无明显致畸作用。

Objective To determine the effects of chemotherapy on ovarian function of women with ovarian carcinoma undergoing preservative operation.Methods30 cases with ovarian carcinoma undergoing one side ovarectomy followed by chemotherapy between Oct 1994 and Jan 2010 whose menstruation,serum hormone levels and reproduction conditions were analysed and patients undergoing one side ovarectomy alone as control group.ResultsAbnormal menstruation occurred in 70% patients,including 40% amenorrhea and 30% oligomenstruate,which appeared after（2.17±0.8）months of chemotherapy and related to the chemotherapy courses.Menstruation of the 12 cases resumed（3.42±1.38）months after the final chemotherapy.Chemotherapy protocols included BEP（16 cases）,PVB（5 cases）,PT（3 cases）and PC（6 cases）caused amenorrhea of 6,1,0 and 5 cases.Menstruation resumed 3 months after chemotherapy.Serum FSH,LH levels rose and E2 level declined during amenorrhea,while 2 cases of occurred oligomenstruate in control group and sex hormone levels were normal,4 of 12 cases planning reproduction delivered their children in the chemotherapy group and the children were healthy.So did 8 of 14 cases in control group.2 cases in chemotherapy group recurred and died.ConclusionsChemotherapy may destroy the ovary function of ovarian carcinoma cancer patient treated by preservative operation.Serum LH,FSH,and E2 levels change and abnormal menstruation occur.However,chemotherapy-related amenorrhea is reversible.Chemotherapy may influence the fertility,while there are no evidence of causing malformation.