卵巢交界性肿瘤复发后再行保留生育功能手术12例临床分析

Retrospective analysis of the clinical outcomes in 12 recurrent borderline ovarian tumor patients with second fertility-sparing surgery

目的探讨复发性卵巢交界性肿瘤（ BOT）患者再次行保留生育功能手术的可行性及临床意义。方法回顾性分析2002年1月至2012年12月复旦大学附属妇产科医院收治的12例复发性BOT患者的临床病理特征及再次施行保留生育功能手术后的月经、生育情况以及肿瘤复发和生存情况。结果（1）12例复发性BOT患者的平均年龄为26岁，再次行保留生育功能手术前均未生育。再次手术后病理检查仍均为BOT，其中10例患者的复发病灶仍局限于卵巢。（2）12例复发性BOT患者中，8例患者再次手术后月经仍规律，4例患者术后月经量减少或经期延长。6例患者术后有妊娠意愿，其中4例（4／6）成功妊娠并顺利分娩。随访时间平均53个月（23～97个月），再次手术后3例患者提示有再次复发可能，其中2例仅为B超检查提示卵巢囊肿，未经手术病理证实；另1例患者再次复发后行第3次保留生育功能手术，术后病理诊断仍为BOT，但未发生与肿瘤相关的死亡。结论对于年轻、有强烈生育要求的复发性BOT患者，可再次行保留生育功能手术，再次手术后妊娠成功率仍较高，但需严密随访。

Objective To analyse the clinical practicability and significance of fertility-sparing surgery for women with recurrent borderline ovarian tumors （ BOT）.Methods The clinical and pathological recordings of 12 patients suffered from recurrent BOT in the Obstetrics and Gynecology Hospital of Fudan University from Jan.2002 to Dec.2012 were analyzed retrospectively.The menstruation situation , fertility function , recurrence rate and survival after second conservative surgery were collected and analyzed .Results The average onset age of these 12 patients was 26 years, and none of them had procreation before the second operation.The pathological diagnosis were still BOT and the recurrent sites of 10 patients were still restricted to the ovaries.Of the 12 cases, 8 cases of them had normal menstruation functions and 4 cases had less menstrual volumes or longer menstrual periods.Among 6 cases desired for pregnancy after the second operation,4 cases of them were successful.The spontaneous pregnancy rate was 4/6.The mean duration of follow-up was 53 months（range：23-97 months）.All recurrent BOT, three cases developed recurrence once more,two cases of them were just be hinted by B ultrasounds and only one cases was approved to be BOT again by a once more surgical pathology.But no disease related deaths occurred.Conclusions The second fertility-sparing surgery may be feasible for women with recurrent BOT who are young and strongly desired for preservation of fertility.The spontaneous pregnancy rate is satisfactory.However, carefully follow-up is still needed.