保守手术对交界性卵巢肿瘤预后及生育功能的影响

The Outcome and Reproductive Function after Conservative Surgery for Borderline Ovarian Tumors

目的:研究首次行保守手术后交界性卵巢肿瘤(BOT)患者的生育功能和预后。方法:对自1990年1月至2000年5月,在我院住院43例符合研究条件的BOT患者,行问卷调查及回顾性病例分析,采用SAS软件包对数据进行处理。结果:43例患者中,41例患者完成问卷调查。26例为浆液性交界性卵巢肿瘤(SBOT);17例为粘液性交界性卵巢肿瘤(MBOT);平均随访时间63个月。术后无肿瘤复发29例,肿瘤复发14例(包括1例死于肿瘤复发,1例死于其它疾病)。平均复发时间为术后39.3个月。卵巢肿瘤剥除术后肿瘤复发率58.3%(7/12),而卵巢切除术后肿瘤复发率22.6%(7/31),两者差异有显著性(Fisher精确概率P=0.0351);但保守手术后肿瘤复发死亡率并不高于根治性手术(P=0.64)。术后24例有生育愿望的妇女,12例获得妊娠。结论:保守手术可作为BOT患者的一种治疗选择;尽管术后肿瘤复发率较高(33%,14/43),尤其是行卵巢肿瘤剥除术的患者,但肿瘤复发死亡率并未增加;术后有妊娠愿望者能够再次妊娠并分娩正常后代。

Objective:To study the prognosis and reproductive function in patients with borderline ovarian tumor(BOT)treated with conservative surgery.Methods:From January1990to May2000,the eligible clinical data being statistically analysed by SAS software package were retrospectively reviewed and questionnaires were accepted in all cases of BOT.Results:Among43patients,41cases had been followed up for63months and had completed our questionnaire.Of 43selected patients,26(60.5%)were classified as serous borderlineovarian tumor(SBOT),17(39.5%)mucous borderline ovaran tumor(MBOT).Twenty-nine patients were free from recurrence after conservative surgery;tumor recurrence occurred in14cases including one patient died of recurrence and another patient died of other disease.The mean recurrence time after conserva-tion surgery was39.3months and the recurrence was more frequent in patients treated with ovar-ian cystectomy than in those treated with oophorectomy alone(58%compared with22%,Fisher Exact Probability=0.0351).The death rate attributed to conservative surgery showed not more than those accepted hysterectomy and bilateral adenexectomy (Fisher Exact Probability =0.64).Moreover,12of24patients attempting pregnancy(50.0%)had conceived.Conclusion:Conserva-tive surgery remains a therapeutic option in selected patients with BOT.Although the rate of re-currence is relatively high especially in those treated with ovarian cystectomy,but mortality fromcancer remains no significant difference in patients between conservative surgery and radical oper-ation,and many patients who desire pregnancy are able to conceive and deliver healthy offspring.