BACKGROUND Endometriosis is a chronic inflammatory condition affecting a significant proportion of women of reproductive age.Although laparoscopic surgery is commonly the preferred treatment,the decision to preserve o...BACKGROUND Endometriosis is a chronic inflammatory condition affecting a significant proportion of women of reproductive age.Although laparoscopic surgery is commonly the preferred treatment,the decision to preserve or remove the ovaries remains controversial.Previous studies have yielded inconsistent results regarding the impact of ovarian preservation vs oophorectomy on fertility outcomes and disease recurrence.This prospective study aimed to address this knowledge gap by comparing the effects of these surgical approaches on spontaneous pregnancy rates,time to pregnancy,recurrence rates,and postoperative pain in patients with endometriosis.AIM To compare the reproductive outcomes and recurrence rates between ovarian preservation and oophorectomy in women undergoing laparoscopic surgery for endometriosis.METHODS This study was conducted at a tertiary care hospital between January 2019 and December 2023.A total of 312 women aged 18 to 40 years,diagnosed with endometriosis and undergoing laparoscopic surgery,were included.The patients were categorized into the ovarian preservation group(n=204)and the oophorectomy group(n=108).The primary outcome measure was the achievement of spontaneous pregnancy within 24 months post-surgery.Secondary outcomes included time to spontaneous pregnancy,recurrence rates,and postoperative pain scores.RESULTS The ovarian preservation group exhibited a significantly higher spontaneous pregnancy rate than that in the oophorectomy group(43.6%vs 28.7%,P=0.006).Moreover,the median time to spontaneous pregnancy was shorter in the ovarian preservation group(8.2 months vs 11.4 months,P=0.018).Nonetheless,endometriosis recurrence was more prevalent in the ovarian preservation group(22.1%vs 11.1%,P=0.014).The postoperative pain scores demonstrated similar improvements in both groups,with no significant differences observed.Subgroup analyses indicated that the benefit of ovarian preservation on spontaneous pregnancy rates was more evident among younger women(≤35 years)and those with advanced-stage endometriosis.CONCLUSION Ovarian preservation is associated with a high spontaneous pregnancy rate and a short time to pregnancy.However,because of the increased risk of recurrence,the decision should be based on age,fertility aspirations,and disease severity.展开更多
AIM: To appraise the current evidence for prophylactic oophorectomy in patients undergoing primary curative colorectal cancer resection.METHODS: Occult ovarian metastases may lead to increased mortality, therefore pro...AIM: To appraise the current evidence for prophylactic oophorectomy in patients undergoing primary curative colorectal cancer resection.METHODS: Occult ovarian metastases may lead to increased mortality, therefore prophylactic oophorectomy may be considered for women undergoing colorectal resection. A systematic review and meta-analysis wasperformed for English language studies from 1994 to 2014(PROSPERO Registry number: CRD42014009340), comparing outcomes following prophylactic oophorectomy(no known ovarian or other metastatic disease at time of surgery) vs no ovarian surgery, synchronous with colorectal resection for malignancy. Outcomes assessed: local recurrence, 5-year mortality, immediate post-operative morbidity and mortality, and rate of distant metastases.RESULTS: Final analysis included 4 studies from the United States, Europe and China, which included 627 patients(210 prophylactic oophorectomy and 417 non-oophorectomy). There was one randomized controlled trials, the remainder being non-randomised cohort studies. The studies were all at high risk of bias according to the Cochrane Collaboration's assessment tool for randomised studies and the NewcastleOttawa Score for the cohort studies. The mean age of patients amongst the studies ranged from 56.5 to 67 years. There were no significant differences between the patients having prophylactic oophorectomy at time of primary colorectal resection compared with patients who did not with respect to local recurrence, 5-year survival and distant metastases. There was no difference in post-operative complications or immediate post-operative mortality between the groups.CONCLUSION: Current evidence does not favour prophylactic oophorectomy for patients without known genetic predisposition. Prophylactic surgery is not associated with additional risk of post-operative complications or death.展开更多
AIM: To investigate the role of estrogen on liver injury in an experimental obstructive jaundice model.METHODS: Three groups of female rats were constituted; group 1 was oophorectomized and given E2 (n = 14), group 2 ...AIM: To investigate the role of estrogen on liver injury in an experimental obstructive jaundice model.METHODS: Three groups of female rats were constituted; group 1 was oophorectomized and given E2 (n = 14), group 2 was oophorectomized and given placebo (n = 14), and group 3 was sham operated (n = 14). Fourteen days following constitution of bile duct ligation, all groups were compared in terms of serum tests, histopathologic parameters, and tissue levels of IFN-γ and IL-6.RESULTS: The parameters representing both the injury and/or the reactive response and healing were more pronounced in groups 1 and 2 (χ2 = 17.2, χ2 = 10.20; χ2 = 12.4, P < 0.05). In the sham operated or E2 administered groups significantly lower tissue levels of IFN-γ and higher IL-6 levels were found. In contrast, high IFN-γ and low IL-6 tissue levels were found in the oophorectomized and placebo group (P < 0.001). Kupffer cell alterations were observed to be more pronounced in the groups 1 and 3 (χ2 = 6.13, P < 0.05).CONCLUSION: Our study indicates that E2 impaired liver functions, accelerated both the liver damage and healing. In the conditions of bile duct obstruction, estrogen significantly changed the cytokine milieu in the liver.展开更多
Objective: Taking tamoxifen orally is the main endocrine therapy of the premenopausal breast cancer with positive hormone receptor, but numerous patients developed to be advanced refractory breast cancer because of d...Objective: Taking tamoxifen orally is the main endocrine therapy of the premenopausal breast cancer with positive hormone receptor, but numerous patients developed to be advanced refractory breast cancer because of drug resistance. Our study investigated a role of the combination of bilateral oophorectomy and exemestane in the management of advanced refractory breast cancer. Methods: The bilateral oophorectomy was carried out in 17 patients. One week after the operation, exemestane was taken orally (25 mg/d). The median time to progression (TTP), the median survival time and the survival rate were calculated using Kaplan-Meier methods. Results: Seventeen patients age ranged from 26 to 44 years (median, 36 years) were treated with an overall response rate of 64.70%, TTP was 8 months and the median survival time was 31 months. The survival rate of 1-year, 3 years and 5 years was 88.24%, 64.71%, 29.41%, respectively. There have no grade Ⅲ/Ⅳ side effects appeared. Conclusion: Bilateral oophorectomy combined with exemestane is safe and effective for advanced refractory premenopausal breast cancer with positive hormone receptor and it is well-torerated.展开更多
Transmasculine individuals,considering whether to undergo total hysterectomy with bilateral salpingectomy,have the option to have a concomitant oophorectomy.While studies have evaluated hormone changes following testo...Transmasculine individuals,considering whether to undergo total hysterectomy with bilateral salpingectomy,have the option to have a concomitant oophorectomy.While studies have evaluated hormone changes following testosterone therapy initiation,most of those patients have not undergone oophorectomy.Data are currently limited to support health outcomes regarding the decision to retain or remove the ovaries.We performed a retrospective chart review of transmasculine patients maintained on high-dose testosterone therapy at a single endocrine clinic in Vancouver,British Columbia,Canada.Twelve transmasculine individuals who underwent bilateral oophorectomy and had presurgical and postsurgical serum data were included.We identified 12 transmasculine subjects as controls,who were on testosterone therapy and did not undergo oophorectomy,but additionally matched to the first group by age,testosterone dosing regimen,and body mass index.There was a statistically significant decrease in the estradiol levels of case subjects postoophorectomy,when compared to presurgical estradiol levels(P=0.02).There was no significant difference between baseline estradiol levels between control and case subjects;however,the difference in estradiol levels at follow-up measurements was significant(P=0.03).Total testosterone levels did not differ between control and case subjects at baseline and follow-up(both P>0.05).Our results demonstrate that oophorectomy further attenuates estradiol levels below what is achieved by high-dose exogenous testosterone alone.Correlated clinical outcomes,such as impacts on bone health,were not available.The clinical implications of oophorectomy versus ovarian retention on endocrinological and overall health outcomes are currently limited.展开更多
McCune-Albright syndrome(MAS)is a rare disease characterized by caféau lait spots,bone fibrous dysplasia,and precocious puberty.Most MAS cases are diagnosed before adolescence.Here,we reported an adolescent girl ...McCune-Albright syndrome(MAS)is a rare disease characterized by caféau lait spots,bone fibrous dysplasia,and precocious puberty.Most MAS cases are diagnosed before adolescence.Here,we reported an adolescent girl underwent mistaken oophorectomy for suspected ovarian tumor,and later,she was diagnosed with MAS.An 11-year-old girl was found to have an irregular pelvic mass measuring 9.74 cm×9.01 cm×7.30 cm with a cyst-solid component and a clear boundary by magnetic resonance imaging.She underwent right oophorectomy for the suspected ovarian tumor.However,histopathological examination showed ovarian tissue with many antral follicles.One week after the surgery,ultrasonography revealed a left pelvic irregular echo-free mass measuring 60 mm×53 mm×48 mm.The patient was then examined by endocrine specialists,and caféau lait spots were found predominantly located on the right side of her waist,hip,and thigh.She had her first period before the surgery,and her serum concentrations of sex hormones were normal.Thus,MAS was diagnosed.The patient has been taking dydrogesterone 20 mg/d for 10 days from the 14th day of her period for 2 years.Ultrasonography performed every 3-6 months revealed no enlargement of her left ovary.Awareness of MAS and careful physical and imaging examination should be emphasized,even in the absence of full classic triad of syndromes.Hence,unnecessary oophorectomy and irreversible loss of fertility potential can be avoided in these patients.展开更多
Approximately one million hysterectomies are performed each year in China. However, national data regarding the indications and the surgical approaches for hysterectomy are lacking. The aim of this study was to examin...Approximately one million hysterectomies are performed each year in China. However, national data regarding the indications and the surgical approaches for hysterectomy are lacking. The aim of this study was to examine the surgical indications for hysterectomy in different age groups and the relative merits of different surgical approaches for hysterectomy in Chinese women. Clinical data from 4653 cases of hysterectomy performed in Tongji Hospital from 2004 to 2009 were analysed. Hysterectomy was most commonly performed among women aged 40-49 years (2299; 49.4%). Overall, colporrhagia and abdominal pain were the two most common indications for hysterectomy. The most common indications by age groups were as follows: malignant ovarian tumour, 〈 20 years; malignant uterine tumour, 20-29 and 30-39 years; uterine myoma, 40-49 and 50-59 years; and uterine prolapse, 60-69 and 〉 70 years. The proportion of malignant aetiology also varied by age, being the highest in women aged 〈 20 years (75.0%) and the lowest in those aged 40-49 years (19.9%). Approximately 35% women who had hysterectomies also had concomitant bilateral oophorectomy. The lowest rate of oophorectomy occurred in women aged 30-39years (15.8%), whereas the highest rate was in those aged 50-59years (75.9%). The abdominal surgical approach was used in 84% of all hysterectomies. Surgeries using the vaginal approach required a significantly shorter operating time (118 min average) than all other approaches (P 〈 0.05). Both the amount of bleeding and the blood transfusion volume required were smaller in vaginal approaches, with no significant differences between the others. The surgical approaches used were also related to the scope of surgery. Both the surgical indications and the rates of bilateral oophorectomy varied by age. In terms of both operating time and the amount of bleeding and blood transfusion volume required, the vaginal approach was superior to all other surgical approaches.展开更多
文摘BACKGROUND Endometriosis is a chronic inflammatory condition affecting a significant proportion of women of reproductive age.Although laparoscopic surgery is commonly the preferred treatment,the decision to preserve or remove the ovaries remains controversial.Previous studies have yielded inconsistent results regarding the impact of ovarian preservation vs oophorectomy on fertility outcomes and disease recurrence.This prospective study aimed to address this knowledge gap by comparing the effects of these surgical approaches on spontaneous pregnancy rates,time to pregnancy,recurrence rates,and postoperative pain in patients with endometriosis.AIM To compare the reproductive outcomes and recurrence rates between ovarian preservation and oophorectomy in women undergoing laparoscopic surgery for endometriosis.METHODS This study was conducted at a tertiary care hospital between January 2019 and December 2023.A total of 312 women aged 18 to 40 years,diagnosed with endometriosis and undergoing laparoscopic surgery,were included.The patients were categorized into the ovarian preservation group(n=204)and the oophorectomy group(n=108).The primary outcome measure was the achievement of spontaneous pregnancy within 24 months post-surgery.Secondary outcomes included time to spontaneous pregnancy,recurrence rates,and postoperative pain scores.RESULTS The ovarian preservation group exhibited a significantly higher spontaneous pregnancy rate than that in the oophorectomy group(43.6%vs 28.7%,P=0.006).Moreover,the median time to spontaneous pregnancy was shorter in the ovarian preservation group(8.2 months vs 11.4 months,P=0.018).Nonetheless,endometriosis recurrence was more prevalent in the ovarian preservation group(22.1%vs 11.1%,P=0.014).The postoperative pain scores demonstrated similar improvements in both groups,with no significant differences observed.Subgroup analyses indicated that the benefit of ovarian preservation on spontaneous pregnancy rates was more evident among younger women(≤35 years)and those with advanced-stage endometriosis.CONCLUSION Ovarian preservation is associated with a high spontaneous pregnancy rate and a short time to pregnancy.However,because of the increased risk of recurrence,the decision should be based on age,fertility aspirations,and disease severity.
文摘AIM: To appraise the current evidence for prophylactic oophorectomy in patients undergoing primary curative colorectal cancer resection.METHODS: Occult ovarian metastases may lead to increased mortality, therefore prophylactic oophorectomy may be considered for women undergoing colorectal resection. A systematic review and meta-analysis wasperformed for English language studies from 1994 to 2014(PROSPERO Registry number: CRD42014009340), comparing outcomes following prophylactic oophorectomy(no known ovarian or other metastatic disease at time of surgery) vs no ovarian surgery, synchronous with colorectal resection for malignancy. Outcomes assessed: local recurrence, 5-year mortality, immediate post-operative morbidity and mortality, and rate of distant metastases.RESULTS: Final analysis included 4 studies from the United States, Europe and China, which included 627 patients(210 prophylactic oophorectomy and 417 non-oophorectomy). There was one randomized controlled trials, the remainder being non-randomised cohort studies. The studies were all at high risk of bias according to the Cochrane Collaboration's assessment tool for randomised studies and the NewcastleOttawa Score for the cohort studies. The mean age of patients amongst the studies ranged from 56.5 to 67 years. There were no significant differences between the patients having prophylactic oophorectomy at time of primary colorectal resection compared with patients who did not with respect to local recurrence, 5-year survival and distant metastases. There was no difference in post-operative complications or immediate post-operative mortality between the groups.CONCLUSION: Current evidence does not favour prophylactic oophorectomy for patients without known genetic predisposition. Prophylactic surgery is not associated with additional risk of post-operative complications or death.
文摘AIM: To investigate the role of estrogen on liver injury in an experimental obstructive jaundice model.METHODS: Three groups of female rats were constituted; group 1 was oophorectomized and given E2 (n = 14), group 2 was oophorectomized and given placebo (n = 14), and group 3 was sham operated (n = 14). Fourteen days following constitution of bile duct ligation, all groups were compared in terms of serum tests, histopathologic parameters, and tissue levels of IFN-γ and IL-6.RESULTS: The parameters representing both the injury and/or the reactive response and healing were more pronounced in groups 1 and 2 (χ2 = 17.2, χ2 = 10.20; χ2 = 12.4, P < 0.05). In the sham operated or E2 administered groups significantly lower tissue levels of IFN-γ and higher IL-6 levels were found. In contrast, high IFN-γ and low IL-6 tissue levels were found in the oophorectomized and placebo group (P < 0.001). Kupffer cell alterations were observed to be more pronounced in the groups 1 and 3 (χ2 = 6.13, P < 0.05).CONCLUSION: Our study indicates that E2 impaired liver functions, accelerated both the liver damage and healing. In the conditions of bile duct obstruction, estrogen significantly changed the cytokine milieu in the liver.
文摘Objective: Taking tamoxifen orally is the main endocrine therapy of the premenopausal breast cancer with positive hormone receptor, but numerous patients developed to be advanced refractory breast cancer because of drug resistance. Our study investigated a role of the combination of bilateral oophorectomy and exemestane in the management of advanced refractory breast cancer. Methods: The bilateral oophorectomy was carried out in 17 patients. One week after the operation, exemestane was taken orally (25 mg/d). The median time to progression (TTP), the median survival time and the survival rate were calculated using Kaplan-Meier methods. Results: Seventeen patients age ranged from 26 to 44 years (median, 36 years) were treated with an overall response rate of 64.70%, TTP was 8 months and the median survival time was 31 months. The survival rate of 1-year, 3 years and 5 years was 88.24%, 64.71%, 29.41%, respectively. There have no grade Ⅲ/Ⅳ side effects appeared. Conclusion: Bilateral oophorectomy combined with exemestane is safe and effective for advanced refractory premenopausal breast cancer with positive hormone receptor and it is well-torerated.
文摘Transmasculine individuals,considering whether to undergo total hysterectomy with bilateral salpingectomy,have the option to have a concomitant oophorectomy.While studies have evaluated hormone changes following testosterone therapy initiation,most of those patients have not undergone oophorectomy.Data are currently limited to support health outcomes regarding the decision to retain or remove the ovaries.We performed a retrospective chart review of transmasculine patients maintained on high-dose testosterone therapy at a single endocrine clinic in Vancouver,British Columbia,Canada.Twelve transmasculine individuals who underwent bilateral oophorectomy and had presurgical and postsurgical serum data were included.We identified 12 transmasculine subjects as controls,who were on testosterone therapy and did not undergo oophorectomy,but additionally matched to the first group by age,testosterone dosing regimen,and body mass index.There was a statistically significant decrease in the estradiol levels of case subjects postoophorectomy,when compared to presurgical estradiol levels(P=0.02).There was no significant difference between baseline estradiol levels between control and case subjects;however,the difference in estradiol levels at follow-up measurements was significant(P=0.03).Total testosterone levels did not differ between control and case subjects at baseline and follow-up(both P>0.05).Our results demonstrate that oophorectomy further attenuates estradiol levels below what is achieved by high-dose exogenous testosterone alone.Correlated clinical outcomes,such as impacts on bone health,were not available.The clinical implications of oophorectomy versus ovarian retention on endocrinological and overall health outcomes are currently limited.
文摘McCune-Albright syndrome(MAS)is a rare disease characterized by caféau lait spots,bone fibrous dysplasia,and precocious puberty.Most MAS cases are diagnosed before adolescence.Here,we reported an adolescent girl underwent mistaken oophorectomy for suspected ovarian tumor,and later,she was diagnosed with MAS.An 11-year-old girl was found to have an irregular pelvic mass measuring 9.74 cm×9.01 cm×7.30 cm with a cyst-solid component and a clear boundary by magnetic resonance imaging.She underwent right oophorectomy for the suspected ovarian tumor.However,histopathological examination showed ovarian tissue with many antral follicles.One week after the surgery,ultrasonography revealed a left pelvic irregular echo-free mass measuring 60 mm×53 mm×48 mm.The patient was then examined by endocrine specialists,and caféau lait spots were found predominantly located on the right side of her waist,hip,and thigh.She had her first period before the surgery,and her serum concentrations of sex hormones were normal.Thus,MAS was diagnosed.The patient has been taking dydrogesterone 20 mg/d for 10 days from the 14th day of her period for 2 years.Ultrasonography performed every 3-6 months revealed no enlargement of her left ovary.Awareness of MAS and careful physical and imaging examination should be emphasized,even in the absence of full classic triad of syndromes.Hence,unnecessary oophorectomy and irreversible loss of fertility potential can be avoided in these patients.
文摘Approximately one million hysterectomies are performed each year in China. However, national data regarding the indications and the surgical approaches for hysterectomy are lacking. The aim of this study was to examine the surgical indications for hysterectomy in different age groups and the relative merits of different surgical approaches for hysterectomy in Chinese women. Clinical data from 4653 cases of hysterectomy performed in Tongji Hospital from 2004 to 2009 were analysed. Hysterectomy was most commonly performed among women aged 40-49 years (2299; 49.4%). Overall, colporrhagia and abdominal pain were the two most common indications for hysterectomy. The most common indications by age groups were as follows: malignant ovarian tumour, 〈 20 years; malignant uterine tumour, 20-29 and 30-39 years; uterine myoma, 40-49 and 50-59 years; and uterine prolapse, 60-69 and 〉 70 years. The proportion of malignant aetiology also varied by age, being the highest in women aged 〈 20 years (75.0%) and the lowest in those aged 40-49 years (19.9%). Approximately 35% women who had hysterectomies also had concomitant bilateral oophorectomy. The lowest rate of oophorectomy occurred in women aged 30-39years (15.8%), whereas the highest rate was in those aged 50-59years (75.9%). The abdominal surgical approach was used in 84% of all hysterectomies. Surgeries using the vaginal approach required a significantly shorter operating time (118 min average) than all other approaches (P 〈 0.05). Both the amount of bleeding and the blood transfusion volume required were smaller in vaginal approaches, with no significant differences between the others. The surgical approaches used were also related to the scope of surgery. Both the surgical indications and the rates of bilateral oophorectomy varied by age. In terms of both operating time and the amount of bleeding and blood transfusion volume required, the vaginal approach was superior to all other surgical approaches.