宫颈鳞癌根治术保留卵巢患者术中是否需行卵巢楔切的回顾性分析

Retrospective analysis of the reserved ovaries whether need wedge resection in cervical squamous cell carcinoma

目的:探讨宫颈鳞癌患者在行根治性治疗时,对外观未见明显异常的卵巢行保留移位术,无需常规做卵巢楔形切除的可行性。方法:回顾性分析2000年1月至2014年12月期间(以手术日期为准)750例卵巢楔形切除的宫颈鳞癌的临床资料,并应用Fisher精确检验分析卵巢转移的高危因素。结果:经术中快速冰冻病理及术后病理组织学证实,750例Ⅰ_a-Ⅱ_b期宫颈鳞癌患者中卵巢转移3例,转移率0.40%;Fisher精确检验分析显示:组织分级(P<0.05)、肌层浸润(P<0.05)、宫体受侵(P<0.05)、宫旁受侵(P<0.05)及盆腔淋巴结转移(P<0.05)与卵巢转移相关。结论:临床Ⅰ-Ⅱ_a期宫颈鳞癌患者行宫颈癌根治术时,对术前影像学、术中肉眼所见卵巢无明显异常者可直接行卵巢移位术,无需行卵巢楔形切除是可行的;Ⅱ_b期患者保留卵巢存在一定风险,需仔细评估卵巢转移高危因素。

Objective： To discuss treating the patients with cervical cancer radical,the ovaries of no obvious abnormalities in the appearance reserve ovarian transposition,without doing the feasibility of conventional ovarian wedge resection. Methods： Retrospective analysis from January 2000 to December 2000 was performed on 750 cases of ovarian wedge resection of the cervical squamous cell carcinomas. Results： Intraoperative frozen section pathology and postoperative histopathology confirmed the ovary transfer was three cases in 750 Ⅰa- Ⅱb cervical squamous cell carcinoma,the transfer rate was 0. 40%. Histological grade（ P〈0. 05）,muscle layer invasion（ P〈0. 05）,palace invasion（ P〈0. 05）,parametrial invasion（ P〈0. 05） and pelvic lymph node metastasis（ P〈0. 05） associated with ovarian metastasis. Conclusion： When clinical Ⅰ- Ⅱ_acervical squamous cell carcinoma patients underwent radical hysterectomy,the patients with no obvious abnormal ovaries by preoperative imaging and intraoperative macroscopic found could be directly for ovarian transposition,without the need for ovarian wedge resection; ovarian preservation of patients with stage Ⅱ_b exist certain risk,need careful assessment of ovarian metastasis risk factors.