宫颈鳞癌患者卵巢移位后卵巢功能的动态监测分析

摘要

目的 探讨宫颈鳞癌患者卵巢移位术后卵巢功能的变化及放射治疗(放疗)对移位卵巢内分泌功能的影响.方法 对2009年1月至2012年6月在江西省妇幼保健院肿瘤科行卵巢移位的53例宫颈鳞癌患者进行回顾性分析.卵巢移位前全部患者激素水平均正常.纳入研究的患者国际妇产科联盟(FIGO)宫颈癌分期标准为ⅠB1～ⅡB且均接受放疗,其中38例ⅠB1～ⅡA2期患者因宫颈鳞癌根治术后存在危险因素补充放疗,15例ⅡB期患者为根治性同步放化疗前行卵巢移位.卵巢移位手术方法包括腹腔镜下卵巢移位和经腹卵巢移位.15例ⅡB期同步放化疗患者均为腹腔镜下卵巢移位;38例行宫颈癌根治术患者中31例为经腹卵巢移位,7例为腹腔镜卵巢移位.53例卵巢移位的患者均接受放疗.通过检测患者治疗前后血清雌二醇(E2)、促卵泡成熟素(FSH)、促黄体生成素(LH)水平监测卵巢内分泌功能.结果 根据FIGO分期,ⅠB1期18例,Ⅰ B2期15例,ⅡA1期3例,ⅡA2期2例,ⅡB期15例.患者年龄28 ～ 44岁,平均37.7岁,中位年龄38岁.22例腹腔镜卵巢移位手术放疗后卵巢功能正常14例(63.6％),与放疗前(100.0％)的差异有统计学意义(P＜0.05).经腹卵巢移位手术放疗后卵巢功能正常22例(71.0％),与放疗前(100.0％)的差异有统计学意义(P＜0.05).经腹卵巢移位术与腹腔镜两组患者放疗后卵巢功能正常比例的差异无统计学意义(P＞0.05).结论 对于接受放疗的年轻宫颈鳞癌患者,即使行卵巢移位术,放疗后卵巢功能受损仍较明显,腹腔镜与经腹卵巢移位术对保护患者卵巢功能差异无统计学意义.%Objective To investigate the changes in ovarian function and the radiotheraputic influence on ovarian function on patients with cervical squamous cell carcinoma.Methods We retrospectively analyzed 53 cases of cervical cancer patients FIGO staging Ⅰ B1-Ⅱ B who had received ovarian transposition surgery at the Maternal and Child Health Hospital of Jiangxi province from January 2009 to June 2012.All the patients included in the study were FIGO staging Ⅰ B1-Ⅱ B and had undergone radiation therapy,including 38 staging Ⅰ B1-Ⅱ A2 cervical cancer patients receiving chemo-therapy after radical radiotherapy due to the presence of risk factors and other 15 patients with stage Ⅱ B to radical concurrent chemoradiotherapy ovarian transposition.Ovarian transposition methods would include laparoscopic ovarian transposition and transabdominal ovarian transposition.15 concurrent patients with stage Ⅱ B who currently receiving chemo-radiotherapy were under laparoscopic ovarian transposition.Among the 38 radical hysterectomy patients,31 were having abdominal ovarian transposition,and the remaining 7 cases were laparoscopic.All the 53 patients had undergone radiotherapy.The levels of serum female hormones FSH,LH,E2 were determined to monitor the ovarian endocrine function.Results According to FIGO staging,18 cases were stage Ⅰ B 1,15 cases Ⅰ B2,3 cases Ⅱ A1,2 cases Ⅱ A2 and 15 cases Ⅱ B.Patients' age range was from 28 to 44 years old,with an average of 37.7 years,median age as 38 years.14 patients (63.6％) were still normal ovarian function after radiotherapy by laparoscopic ovarian transposition,which was 100.0％before radiotherapy.There was a significant difference (P＜0.05) compared with before radiotherapy.After transabdominal ovarian transposition surgery and radiotherapy,normal ovarian function 22 cases (71.0％),and there was a significant difference (P＜0.05) compared with before radiotherapy.No significant difference was found with regard to the proportion of normal ovarian function after radiotherapy between the two groups of patients with laparoscopic and transabdominal ovarian transposition (P＞0.05).Conclusion For the young cervical cancer patients,even with ovarian transposition,ovarian dysfunction was still evident after radiotherapy.There was no significant difference between laparoscopic and transabdominal ovarian transposition.