保留生育功能手术治疗原发性卵巢黏液癌的效果分析

Effect analysis of fertility preserving surgery for the treatment of primary ovarian mucinous carcinoma

目的 探讨有生育要求的原发性卵巢黏液癌患者行手术治疗的临床效果.方法 选取行手术治疗的有生育要求的原发性卵巢黏液癌患者51例进行分析,检测并分析患者术后血清促卵泡激素（FSH）、黄体生成素（LH）、雌二醇（E2）、抗苗勒管激素（AMH）的水平变化,并对患者进行3年随访,观察患者的生存率、生育情况.结果 该组进行手术的51例患者,术后7 d、14 d,血清FSH、LH均较术前升高（F=24.198、21.554,均P〈0.05）,E2、AMH、卵巢基质动脉血流的收缩期峰值（PSV）测定值均较术前降低（F=24.407、35.028、11.064,均P〈0.05）;术后随访至2015年6月,期间共有4例因肿瘤复发死亡、2例失访,45例存活,生存率为88.23%;45例存活患者中,41例月经周期、月经量均正常,月经周期26～31 d,平均（28.2±2.2）d;4例月经不规律.随访的44例已婚患者中,其中28例成功妊娠,妊娠率63.64%.妊娠患者中有4例自然流产、3例因孕期检查发现异常进行人工流产、17例足月妊娠、4例早产.结论 原发性卵巢黏液癌患者采用保留生育功能手术临床可行,术后妊娠率较高,但术后应加强随访和监测,避免因肿瘤复发导致患者不良预后.

Objective To analyze the clinical value of ovarian surgery in the treatment of primary ovarian mucinous carcinoma patients with fertility requirements.Methods 51 cases with fertility requirements with primary ovarian mucinous carcinoma who received surgical treatment were analyzed.The postoperative serum follicle stimulating hormone （FSH） and luteinizing hormone （LH）,estradiol （E-2）,anti Mullerian hormone （AMH） were deteced.The patients were followed up for 3 years,the survival rate and fertility were observed.Results Of 51 patients underwent surgery,postoperative 7d,14d,the FSH,LH levels in serum were higher than before operation （F=24.198,21.554,all P〈0.05）,E-2,AMH,PSV values were lower than before operation （F=24.407,35.028,11.064,all P〈0.05）.During the follow-up period to June 2015,there were 4 patients died of tumor recurrence,2 patients were lost to follow-up,45 patients survived,the survival rate was 88.23%.Of 45 patients survived,41 patients were normal menstrual cycle,menstruation,menstrual cycle 26-31 d,average （28.2±2.2）d;4 patients with irregular menstruation.Married women in the follow-up of 44 cases,including 28 patients with successful pregnancy,the pregnancy rate was 63.64%,there were 4 cases of spontaneous abortion,pregnancy in 3 patients because of abortion,pregnancy examination found 17 cases of abnormal pregnancy,4 cases of premature delivery.Conclusion In patients with primary ovarian mucinous carcinoma,it is feasible to use fertility preserving function,and the pregnancy rate is high,but the follow-up and monitoring should be strengthened to avoid the bad prognosis.