宫颈癌患者保留卵巢的临床价值

Clinical value of preservation of ovary in patients with cervical cancer

目的：探讨宫颈癌患者行卵巢腹腔内移位术后卵巢的功能。方法：收集2005年1月～2010年3月间，贵州省人民医院妇科收治的32例手术治疗同时行卵巢移位的绝经前宫颈癌患者，定期随访患者的自觉症状，定期监测外周血雌二醇（E2）、卵泡刺激素（FSH）水平，B超测定移位卵巢的位置、大小、血流阻力指数（RI），综合评定移位卵巢的功能。结果：未放疗组和放疗组的同期E：、FSH比较差异均无统计学意义（P〉0．05）。未放疗组术前和术后各月激素水平比较，差异均无统计学意义（P〉0．05）。放疗组于术前和术后1、3、6月各项激素比较，差异均无统计学意义（P〉0．05），但与术后12月激素水平相比，差异有统计学意义（P〈0．05），表现为卵巢功能下降。所有移位卵巢经彩超检查均可见周期性变化及卵泡发育。监测卵巢血流RI，未放疗组术前和术后各月相比，差异均无统计学意义（P〉0．05）。而放疗组除术后12月和术前RI比较差异有统计学意义（P〈0．05）外，其余术后各月与术前相比，差异无统计学意义（P〉0．05）。两组同期RI比较，除术后12月有统计学差异（P〈0．05），其余时点RI差异无统计学意义（P〉0．05）。RI与E2呈负相关（r=-0．906，P〈0．01），RI与FSH呈正相关（r=0．886，P〈0．01）。结论：年轻宫颈癌患者行手术治疗同时行卵巢移位术，可保全大多数患者的卵巢功能，术后随访B超监测卵巢血流阻力指数可作为评估卵巢功能的重要指标。

Objective： To explore the function of transposed ovary in patients with cervical cancer after intraabdominal ovarian transposition. Methods： Thirty - two premenopausal patients with cervical cancer treated by cervical cancer operation and intraabdominal o- varian transposition in gynecological department of the hospital from January 2005 to March 2010 were collected; the subjective symptoms of these patients were followed up; the levels of estradiol and follicle - stimulating hormone （FSH） in peripheral blood were monitored regularly ; the location, size and blood flow resistance index （ RI ） were measured by ultrasound ; the function of transposed ovary was evaluated comprehensively. Results： There was no statistically significant difference in serum levels of estradiol and FSH between radiotherapy group and non - radiotherapy group （ P 〉 0. 05 ） . In non - radiotherapy group, there was no statistically significant difference in serum levels of estradiol and FSH between before operation and different months after operation （P 〉 0. 05 ） . In radiotherapy group, there was no statistically significant difference in serum levels of estradiol and FSH between before operation and 1,3 and 6 months after operation （ P 〉 0.05 ） , but there were statistically significant differences between before operation and 12 months after operation （P 〈 0. 05 ） , the manifestation was decline of ovarian function. Cyclic variation and follicular development were observed in all the transposed ovaries under ultrasound. There was no statistically significant difference in ovarian blood flow RI between before operation and different months after operation （ P 〉 0. 05 ） . In radiotherapy group, there was statistically significant difference in ovarian blood flow RI between before operation and 12 months after operation （P 〈0. 05）, but there was no statistically significant difference between before operation and 1, 3 and 6 months after operation （P 〉 0. 05） . There was statistically significant difference in ovarian blood flow RI at 12 months after operation between radiotherapy group and non - radiotherapy group （ P 〈 0. 05 ） , but there was no statistically significant difference before operation and at 1,3 and 6 months after operation between the two groups （P 〉 0. 05 ） . RI was negatively correlated with estradiol level （ r = - 0. 906, P 〈 0. 01 ）, while RI was positively correlated with FSH level （ r = 0. 886, P 〈 0. 01 ） . Conclusion ： Cervical cancer operation combined with intraabdominal ovarian transposition can preserve ovarian function of most young cervical cancer patients, ovarian blood flow RI monitored by uhrasonography during postoperative follow - up can be used as one of important indexes to evaluate ovarian function.