改良式卵巢移位术在子宫颈癌根治术中的应用

Application of intrafascia ovarian transposition in radical surgery of early cervical carcinoma

目的探讨改良式卵巢移位术在宫颈癌根治术中的临床应用。方法选择2009年1月～2012年7月在襄阳市中心医院治疗的宫颈癌患者46例，根据术式不同分为实验组30例及对照组16例。实验组患者行改良式卵巢移位术，对照组患者行腹部腹膜外卵巢移位术。比较两组患者阴道细胞学检查结果，术前和术后6个月促卵泡成熟激素（FSH）、促黄体生成激素（LH）、雌二醇（E2）、孕酮（P）水平及彩超结果。结果①两组患者术后均行常规细胞学检查，均没有异常。②所有患者术前血清E2、P、FSH及LH水平[（173．58±59．55）U／L、（1．16±0．83）U／L、（5．84±1．04）pg/mL、（9．42±3．59）g／mL]与术后6个月比较[（169．97±53．64）U／L、（1．29±0．75）U／L、（5．66±0．94）pg／mL、（9．05±4．01）g/mL]，差异均无统计学意义（P〉0．05）。③实验组无并发症，对照组患者有7例（43．75％）出现并发症，其中5例患者出现移位侧腹部和盆腔疼痛，2例为卵巢皮下移位。实验组患者并发症发生率明显低于对照组，差异有统计学意义（P〈0．05）。结论无论任何一种卵巢移位术只要卵巢远离盆腔，术后均可保留45岁以下宫颈癌患者的卵巢功能，但腹膜内卵巢移位术在减轻术后并发症方面明显优于腹膜外卵巢移位术。

Objective To observe the clinical application of intrafascia ovarian transposition in radical surgery of early cervical carcinoma. Methods 46 cases of cervical carcinoma from January 2009 to July 2012 in the Center Hospital of Xiangyang City were selected and divided into experiment group with 30 cases and control group with 16 cases. The experiment group was treated with improved ovarian transposition, the control group was treated with abdominal ex- traperitoneal ovarian transposition. Vaginal cytology results and color Doppler ultrasound results between the two groups was compared. The serum level of FSH, LH, E2, P before and 6 months after the operation between the two groups were compared. Results ①All the patients were examined by conventional cytology, no anomaly was found. ②The differences of serum level of E2, P, FSH, LH between the pre-operation [（173.58±59.55） U/L, （1.16±0.83） U/L, （5.84±1.04） pg/mL, （9.42±3.59） g/roLl and 6 months postoperation [（169.97±53.64）U/L, （1.29±0.75） U/L, （5.66±0.94） pg/mL, （9.05±4.01） g/mL] were not statistically significant （P 〉 0.05）. ③No complication was found in experiment group, 7 cases （43.75%） with complication were found in control group including 5 cases of lateral displacement of abdominal and pelvic pain and 2 cases of ovary subcutaneous shift. The complication occurrence rate in experiment group was lower than that in control group, the difference was statistically significant （P 〈 0.05）. Conclusion Ovarian transposition is helpful for reserving o- varian function in young patients under 45 years old with ovarian keeping away from pelvic cavity. Intrafaseia ovarian transposition leads to less complications than control group.