卵巢交界性肿瘤保留生育功能手术的疗效评价

Clinical Efficacy Evaluation of Fertility-preserving Surgery in the Treatment of Borderline Ovarian Tumors

目的探讨卵巢交界性肿瘤(borderline ovarian tumors, BOTs)患者行保留生育功能手术的临床疗效。方法回顾性分析2008年1月~2020年1月在辽宁省肿瘤医院就诊的144例BOTs患者的临床资料(包括患者年龄、手术方式、临床分期、高危因素、是否术后化疗、是否复发),分析保留生育功能手术(Fertility sparing surgery, FSS.)与根治手术(Radical surgery, RS.)的临床效果及生育情况,比较保留生育功能不同手术方式的复发率、妊娠率,用Kaplan-Meier法进行生存分析。结果所有患者中,FSS组总体复发率13.79%高于RS组总体复发率2.63%,比较有统计学差异(P=0.015)。保留生育功能不同术式的复发率比较,卵巢病损切除(包括单侧和双侧)复发率36.36%高于单侧附件切除8.11%、单侧附件+对侧卵巢病损切除10%,比较没有统计学差异(P=0.052)。FSS组3年、5年、10年生存率均为100%,中位DFS为40个月;RS组3年、5年、10年生存率为97.44%、97.96%、97.33%,中位DFS为45.5个月,两组比较无统计学差异(P=0.190)。FSS组无死亡病例,RS组2例死于肿瘤复发。FSS组1年、2年、3年妊娠率5.17%、8.62%、10.34%。结论卵巢交界性肿瘤行保留生育功能手术有复发风险,但不影响患者总生存率;妊娠率随着术后时间延长而增加。

Objective To discuss the clinical efficacy of fertility sparing surgery(FSS) in the therapy of sick person with borderline ovarian tumors(BOTs).Methods A retrospective analysis of the clinical data of 144 BOTs patients treated in Liaoning Cancer Hospital from January 2008 to January 2020(including patient age, surgical methods, clinical stage, high-risk factors, postoperative chemotherapy and recurrence),analysis of clinical efficacy and fertility condition of FSS(Including ovarian lesion resection, unilateral adnexectomy, unilateral adnexectomy + contralateral ovarian lesion resection) and radical surgery(Including bilateral appendages, total uterus + bilateral appendage resection).We were compared with the recurrence rate and pregnancy rate of different surgical methods to preserve fertility.The Kaplan-Meier method was used for survival analysis.Results Among all patients, the overall recurrence rate of the FSS group was 13.79% higher than that of the radical surgery(RS) group was 2.63%,which was statistically different(P=0.015).Comparing the recurrence rate of different surgical procedures for preserving fertility, there are no statistical differences(P=0.052).The recurrence rate of ovarian lesion resection(including unilateral and bilateral) was 36.36% higher than that of unilateral attachment resection 8.11%,and unilateral attachment + contralateral ovarian lesion resection10%.The 3 year, 5 year, and 10 year survival rates in the FSS group were all 100%,and the median DFS was 40 months;the 3 year, 5 year, and 10 year survival rates in the RS group were 97.44%,97.96%,and 97.33%,and the median DFS was 45.5 months, and there was no statistical difference between the two groups(P=0.190).There were no deaths in the FSS group, and 2 patients in the RS group died of tumor recurrence.The pregnancy rates of 1 year, 2 years and 3 years in the FSS group were 5.17%,8.62%,and 10.34%.Conclusion There is a risk of recurrence of FSS for BOTs, but it does not affect the overall survival rate of the patient;the pregnancy rate increases with the postoperative time.