年轻子宫颈鳞癌患者腹腔镜手术保留卵巢功能的临床研究

目的:探讨年轻子宫颈鳞癌患者腹腔镜手术并结肠旁沟卵巢侧面移位术后(LOT)卵巢内分泌功能和并发症及新辅助动脉化疗(NACT)在宫颈鳞癌患者卵巢保护中的作用。方法:选取石河子大学医学院第一附属医院妇科2005年4月～2007年10月、腹腔镜宫颈鳞癌手术时行LOT者19例(术前NACT7例)及卵巢原位保留的3例共22例早期年轻(手术年龄<45岁)子宫颈鳞癌患者为研究对象,测定患者手术前后血清女性激素水平、B超检查及患者填写围绝经期综合征量表,调查术后卵巢内分泌功能及并发症的情况。结果:LOT未放疗组术后女性激素水平、Kupperman评分与术前并无显著性差异(P>0.05);LOT放疗组FSH、LH、Kupperman评分高于未放疗组(P<0.05),但显著低于原位保留放疗组(P<0.05);术前行NACT再行手术及LOT的7例,完全缓解(CR)2例,部分缓解(PR)4例,稳定(NC)1例,有效率(CR+PR)85.7%;19例LOT患者随访中无1例发生转移,1例术后1个月盆腔积液,1例术后间歇性右侧移位卵巢部位轻微疼痛。结论:LOT是保留年轻宫颈鳞癌患者卵巢功能有效的方法;卵巢移位后减少了放疗对卵巢内分泌功能的损害,但放疗对移位卵巢还是有一定影响,并不能完全避开放射线的照射;新辅助动脉化疗使部分中、晚期患者保留卵巢成为可能,值得推广;LOT术后并发症发生率较低。

Clinical study of preserving ovarian function by laparoscopic surgery in young patients with early stage cervical squamous carcinoma

Objective:To investigate the ovarian function and the sequelae in yang women with early stage cervical squamous carcinoma undergoing radical hysterectomy,pelvic lymphadenectomy and LOT,as well as the role of neoadjuvant chemotherapy in protecting the ovarian function of cervical squamous carcinoma.Methods:22 cases under 45 years old with cervical squamous cancer were surveyed,including 19 cases undergoing radical hysterectomy, pelvic lymphadenectomy and lateral ovarian transposition(LOT) (including 9 cases undergoing neoadjuvant chemotherapy) and 3 cases whose ovarian were retained in situ.The Kupperman standard (1995) was used to investigate the climacteric syndrome,levels of FSH,LH,E2 and INHB were detected to judge ovarian function.Ultrasound was used to image the transposed ovaries to find out the sequela of LOT.Results:The female hormone levels and Kupperman score of 13 cases who underwent LOT had no difference before operation and after operation (P>0. 05) in three to six months.The levels of FSH and LH,Kupperman score in LOT and postoperation radiotherapy group were higher than those in the no radiotherapy group (P<0.05),but were significantly higher than those whose ovarian were retained in situ(P<0.05).Among 7 patients undergoing operating after neoadjuvant chemotherapy, tumor focus of 2 cases were disappeared (CR),4 cases were partial recovery (PR),1 case was no recovery (NR),the total response rate(CP+PR) was 85.7%.Among 19 LOT patients,only one case had pelvic effusion,one had intermittent slight pain in the right position where the ovarian was transposed.Conclusion:LOT is effective in retaining the ovary functions of early stage cervical squamous carcinoma patients.Pelvic radiotherapy after LOT can greatly protect the ovary function, but it also can damage the transposed ovarian partly.By neoadjuvant chemotherapy,retaining ovarian function is possible in partly patients with advanced cervical squamous carcinoma,so neoadjuvant chemotherapy should be promoted;the rate of sequelae after LOT is very low.