宫颈癌根治术时行卵巢移植术或移位术的远期疗效

Long Term Effect of Ovary Transplantation or Transposition in Radical Treatment of Cervical Cancer

目的 :探讨早期子宫颈癌患者几种不同保留卵巢手术方式的效果及术后放疗对保留卵巢的影响。方法 :2 6例 41岁以前的宫颈癌患者行根治性手术的同时 ,2例行卵巢移植术 ,2 4例行卵巢移位术 ,利用 B超及测定血清性激素水平等方法定期监测保留卵巢的功能。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 12年 ,卵巢功能正常。 1例随访 10年 ,术后 9年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～ 8年 ,平均 6 .2年。 15例术后 1个月辅助放射治疗 ,放疗结束 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～ 6年 ,平均 4.5年。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 .0 5 )。放射治疗组与未接受放疗组 5年生存率分别为 90 .6 %和 10 0 % (P>0 .0 5 )。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 ,放射治疗对移位的卵巢功能有不良影响。

Objective:To evaluate the long term effect of transplantation or transposition of ovary in radical treatment of cervical cancer.Methods:During the radical operation of cervical cancer in 26 patients with the age below 41 years,ovary transplantation was performed in 2 cases and ovary transposition was performed in 24 cases simultaneously.B ultrasonic and serum concentration of sex hormone were examined at regular intervals to evaluate the functions of these 2 kinds of preservation of ovary.Results:It revealed that the ovaries of the transplatation group enlarged in the first period of 6 months postoperatively,but it returned to normal 9-15 months postoperatively.The ovarian function kept normal for 12 years in one case and another patient had nearly normal sex hormone level for 9 years in 10-year follow up.In the transposition group,9 patients who had not received radiation kept normal ovarian function for 5-8 years postoperatively (averagely 6.2 years).Fifteen patients who received accessory radiotherapy one month postoperatively resumed their menstrual cycle 6 months after radiation.93.3% (14/15) of the patients sustained their ovarian function for 4-6 years (averagely 4.5 years).A significant difference existed between accessory radiation group and the group had not received radiation (P<0.05) respectively.Conclusion:Transposition of ovary is an effective and simple method for preservation of ovarian function in young cervical cancer patients after radical operation,but radiotherapy has adverse effect for transposed ovary function.