GnRHa在非良性卵巢肿瘤保留生育功能患者中的应用

The Application of Gonadotropin-Releasing Hormone Agonists in Non-Malignant Ovarian Tumor Patients

目的:观察非良性卵巢肿瘤患者在接受保留生育功能手术后,接受化疗前及化疗中联合应用促性腺激素释放激素激动剂(GnRHa)的疗效。方法:回顾性分析我院收治的年龄≤40岁,因非良性卵巢肿瘤行保留生育功能治疗、自愿于化疗前和化疗中接受GnRHa治疗、有随访的患者18例为GnRHa组,另选择应用相同治疗方案而未进行GnRHa治疗的18例(同期6例和既往12例)患者为对照组,比较两组月经状况及生育结局。结果:在治疗结束后的2年内,GnRHa组中复发1例(5.6%),对照组复发2例(11.1%)。治疗结束后的6个月,GnRHa组恢复正常月经比例(100.0%)高于对照组(66.7%,12/18),差异有统计学意义(P<0.05)。两组患者已婚者有生育要求均6例,其中GnRHa组自然妊娠5例,自然妊娠率(83.3%),获得新生儿4例;对照组自然妊娠2例,自然妊娠率33.3%,获得新生儿2例。所有新生儿均健康。结论:对保留生育功能的非良性卵巢肿瘤患者于化疗前和化疗中联合应用GnRHa可保护患者卵巢功能,提高治疗后正常月经恢复率,提高妊娠率,但仍需长期随访及大规模临床试验以验证。

Objective：To observe the clinical effect of gonadotropin-releasing hormone agonists （GnRHa） cotreatment during chemotherapy in non-malignant ovarian tumor patients who had undergone the conserva- tive surgery. Methods：The clinical data of 18 patients who were treated with fertility preservation surgery for non-malignant ovarian tumors and then administered GnRHa during chemotherapy（study group） in Peking University People＇s Hospital from January 2006 to December 2011 were retrospectively analyzed. This group was compared with a control group of 18 women who were treated concurrently with similar chemotherapy （n =6） without GnRHa or were historical controls （n =12）. The disease recurrence, the menstruation sta- tus and reproductive outcome were followed up and compared between the two groups. Results：One patient （5.6%） in the study group while 2 patients （ 11.1% ） in the control group relapsed 2 years after conclusion of the primary treatment. All of the 18 women （100.0%） in the study group compared with 12 of the 18 patients in the control group（66. 7% ） resumed normal menses 6 months after the termination of the treatment （P 〈 0.05）. There were 5 spontaneous pregnancies in the study group（ natural pregnancy rate：83. 3% ） while 2 in the control group（natural pregnancy rate：33.3%）, all of the neonates were healthy. Conclusions.Gn- RHa administration before and during chemotherapy in non-malignant ovarian tumors patients who have un- dergone fertility preservation operation may bring up higher rates of spontaneous resumption of menses and a better pregnancy rate. Long-term follow up and large scale clinical studies are required to confirm the con- clusion.