肿瘤治疗对女性生育力的影响及其机制与风险评估

Mechanisms and risk assessment of cancer female fertility impairment

肿瘤的主要治疗方法包括手术、放疗和化疗。卵巢囊肿剔除由于常伴随正常卵巢皮质组织的损失，可导致术后不同程度的卵巢储备下降，其中卵巢子宫内膜异位囊肿剔除术尤其容易导致卵巢储备的受损。放疗、化疗通过卵巢各级细胞凋亡、削弱卵巢血供以及加速卯泡募集等机制导致卵巢储备迅速提前耗竭。此外，放疗还可能导致子宫结构和功能的改变，从而导致妊娠并发症发生率上升。卵巢基础窦卵泡计数以及血清抗苗勒管激素是目前评估卵巢储备的较为灵敏、准确的方法。

Surgical resection, radiotherapy and chemotherapy are the current mainstays of cancer treat- ments. During ovarian cystectomy, part of the normal ovarian cortex could be resected together with ovarian mass, which suppresses ovarian reserve postoperatively. This reduction in ovarian reserve is especially produced after resection of ovarian endometriomas. On the other hand, radiotherapy and chemotherapy may cause cell apoptosis, diminish blood supply in the ovaries and weaken the brake on follicular recruitment. Brought togeth- er, these mechanisms give rise to accelerated deprivation of ovarian follicles, and hence undermine fecundity of the affected individuals. Moreover, radiotherapy could result in alterations in structure and functions of uterus and other pelvic organs, which translate into increased incidence of obstetric complications later on. Currently antral follicular count and serum anti-Mfilleriau hormone are the most sensitive and accurate measurements of ovarian reserve.