影响年轻宫颈癌患者放疗后卵巢功能相关性因素分析

Analysis of Factors Influencing Ovarian Function in Young Patients with Cervical Carcinoma after Radiotherapy

目的:探讨年轻宫颈癌患者在放射治疗前行卵巢移位术,维持卵巢内分泌功能与移位卵巢位置的关系。方法:回顾性分析梧州市红十字会医院2012年6月—2016年6月行卵巢移位术的72例年轻宫颈癌患者的临床资料,通过观察患者发生的围绝经期症状并结合血清卵泡刺激素(FSH)、黄体生成激素(LH)及雌二醇(E2)水平评估卵巢内分泌功能。结果:经重复测量方差分析表明,不同组间、不同时间点血清FSH、LH和E2水平不同,差异均有统计学意义(P<0.05)。受试者工作特征(ROC)曲线分析显示,保持卵巢功能的移位卵巢位置最佳截断值是超过髂嵴连线1.5 cm以上的位置(ROC曲线下面积:0.747,95%CI:0.593~0.902);年龄最佳截断值是32.5岁(ROC曲线下面积:0.692,95%CI:0.522~0.860)。多因素分析显示,高于及位于髂嵴连线1.5 cm移位卵巢的位置(OR=0.09,95%CI:0.014~0.571)以及年龄≤32.5岁(OR=0.062,95%CI:0.006~0.655)是保护卵巢功能的重要因素。结论:推荐卵巢移位的位置超过髂嵴连线1.5 cm以上以便于年轻宫颈癌患者行放射治疗时避免卵巢功能损伤。

Objective：To evaluate the association of ovarian transposition procedures in preserving ovarian function in relation to the location of the transposed ovaries in young cercical carcinoma patients who underwent the radiotherapy.Methods：The clinical data of 72 young patients with cervical cancer who underwent ovarian transposition between June 2012 and June 2016 in Wuzhou Red Cross Hospital were analyzed retrospectively.Ovarian endocrine function was assessed by observing the symptoms of perimenopausal period and serum FSH,LH,E2 level.Results：Based on receiver operator characteristic curve analysis,optimum cutoff value of location more than 1.5 cm above the iliac crest was significantly associated with preservation of ovarian function after treatment（area under receiver operator characteristic curve：0.747,95% CI：0.593-0.902）.Optimum cutoff value of age was 32.5（area under receiver operator characteristic curve：0.692,95% CI：0.522-0.860）.Multivariate analysis confirmed that the location of transposed ovary higher than or equal to 1.5 cm above the iliac crest（OR=0.09,95%CI：0.014-0.571） and less than or equal to 32.5 years old（OR=0.062,95%CI：0.006~0.655） were the most important factor for preserve ovarian function.Conclusions：The position of transposed ovary higher than 1.5 cm above the iliac crest is recommended to avoid ovarian damage after ovarian transposition after radiotherapy in young cervical carcinoma women.