宫颈癌根治术中行卵巢移位的临床效果分析

目的探讨宫颈癌根治术中行卵巢移位术术后卵巢的功能状况。方法1999年1月至2003年12月江门市新会区人民医院等2家医院收治43例年龄26~40岁宫颈癌ⅠB~ⅡA期患者,其中22例在宫颈癌根治术中行卵巢移位术为观察组,21例行传统的宫颈癌根治术为对照组。术后应用血FSH、LH、E2及Kuppermann评分进行卵巢功能测定,随访1~4年。结果观察组术后4年内卵巢功能基本正常,对照组术后1个月卵巢功能丧失。两组记录生存质量的改良Kuppermann评分比较差异有非常显著性意义(P<0·01),而复发率和存活率比较差异无显著性意义(P>0·05)。结论宫颈癌患者在宫颈癌根治术时行卵巢移位术,可保留卵巢功能。     

卵巢癌术后化疗卵巢功能保护相关问题

化疗期间的卵巢功能保护是卵巢癌患者保留生育功能手术后急需解决的问题。文章对促性腺激素释放激素激动剂、细胞保护剂、中医药等方面的保护措施的研究进行总结分析。     

宫颈癌卵巢侧面移位术后卵巢内分泌功能及并发症的监测

目的调查宫颈鳞癌年轻患者卵巢侧面移位术后（LOT）卵巢内分泌功能和并发症发生率。方法对中山大学附属第二医院1998年1月至2004年1月接受宫颈癌根治性手术及LOT治疗的47例早期宫颈鳞癌年轻患者进行3次相隔半年的调查，通过围绝经期综合征量表结合血中卵泡刺激素（FSH）值判断卵巢内分泌功能；超声检查移位卵巢了解LOT术后并发症。结果3次调查中，保留正常卵巢内分泌功能的比率在术后没有辅助盆腔外放疗组分别为90．9％，88．5％，85．7％；术后加用辅助放疗组分别为81．3％，73．3％，71．4％；两组之间差异没有显著性意义（P〉0．05）；在手术年龄低于40岁的患者中为96．4％，93．5％，93．3％；手术年龄40-45岁的患者中为60．0％，50．0％，41．7％；两组之间差异有显著性意义（P〈0．05）。卵巢移位术后主要并发症为症状性卵巢囊肿，其发生率分别为5．3％，4．9％，4．8％。结论LOT能够保护卵巢不受盆腔外放疗的损伤；手术年龄与移位卵巢内分泌功能的保留有相关性；LOT术后发生的并发症主要为症状性卵巢囊肿，其发生率低。     

宫颈癌根治术中卵巢移位后卵巢功能的临床研究

目的:探讨宫颈癌根治术中卵巢移位对卵巢功能的影响。方法:回顾性分析2004年1月至2007年12月我院收治的早期宫颈癌31例,行广泛性全子宫切除+盆腔淋巴结清扫术同时行卵巢移位,术后随访患者有无绝经期症状,彩色多普勒超声监测卵巢形态、位置、大小、血供及盆腔情况,并行阴道脱落细胞学检查,测定血清中FSH、E2水平并行统计学分析,以判断术前、术后卵巢功能的改变情况。结果:31例患者卵巢移位后未出现绝经期症状;31例移位卵巢的大小,形态,血供均无异常,卵泡有周期性增大,无卵巢脱落;术后按常规行阴道细胞学检查无一例发现异常;术前、术后血激素水平差异无显著意义(P>0.05)。结论:卵巢移位不影响年轻宫颈癌患者卵巢功能。     

Ovarian transposition in young patients with invasive cervical cancer receiving radiation therapy

Twenty-two patients with invasive cervical cancer had ovarian transposition. Fifteen patients received whole pelvic external radiation therapy via a teletherapy unit, and nine patients also received one or two intracavitary insertions. Ovarian function was measured by serum gonadotropins, FSH, and LH. We were unable to measure gonadotropin levels in four patients because they were lost to follow-up after completion of radiation therapy. Five patients developed postmenopausal symptoms; in two the ovaries were not shielded and they received radiation by lateral ports with an average dose above 2500 cGY. Therefore, ovarian function was preserved in seven of 11 patients (64%), all of whom received 500 cGY with an average dose of 250 cGY to the ovaries via external radiation and intracavitary insertion(s). FSH values ranged from 3.3 to 38.8 mlU ml⁻¹ (mean = 17.7 mlU ml⁻¹). Two patients developed symptomatic ovarian cysts. Ovarian function can be preserved by transposing the ovaries at the time of surgery prior to radiation with adequate treatment planning which limits the radiation dose to the ovaries to 300 cGY.     

宫颈鳞癌患者放疗前行腹腔镜卵巢移位术30例临床效果分析

目的:探讨宫颈鳞癌患者在放疗前行腹腔镜下卵巢移位术对卵巢内分泌功能的影响。方法:研究组(n=30):选择40岁以下ⅡB～ⅢA期宫颈鳞癌患者,在放疗前行腹腔镜下卵巢移位术;对照组(n=20)为同期确诊的40岁以下ⅡB～ⅢA期宫颈鳞癌患者,未接受卵巢移位术直接放疗者。两组分别于放疗前、放疗后12月测患者卵泡期血清E2、FSH和LH水平,行围绝经期综合征量表(Kupperma)评分,观察其围绝经期症状出现情况。结果:研究组和对照组放疗前患者的E2、FSH和LH水平及均Kupperman评分比较,差异无统计学意义(P>0.05);研究组放疗后12个月16例出现卵巢功能下降,对照组则2例出现卵巢功能下降,18例出现卵巢功能丧失;两组间激素水平及Kupperman评分比较,差异有统计学意义(P<0.05)。结论:年轻晚期宫颈鳞癌患者放疗前行腹腔镜下卵巢移位术,可使卵巢功能得到一定的保护。     

Heterotopic autotransplantation of cryobanked human ovarian tissue as a strategy to restore ovarian function

OBJECTIVE: To investigate ovarian function after heterotopic autotransplantation of human ovarian tissue banked at -196 degrees C. DESIGN: A clinical case study. SETTING: University medical center. PATIENT(S): A 37-year-old woman with cervical cancer (stage Ib). INTERVENTION(S): Frozen-thawed human ovarian tissue was transplanted to two different heterotopic sites. MAIN OUTCOME MEASURE(S): Ovarian function of the grafts was monitored sequentially by blood sampling for the hormonal profiles and by ultrasound. RESULT(S): The hormonal profile remained at the postmenopausal level until 10 weeks after transplantation. By 14 weeks, the return of ovarian function was evidenced by the elevation of the serum E(2) level (57.5 pg/mL). While monitoring hormonal profiles every 2 days for 5 weeks, we observed the LH surge (69.8 IU/L) followed by the elevation of the P(4)concentration (9.6 ng/mL), suggesting presumptive ovulation. The ultrasound revealed a dominant follicle on the rectus muscle in the abdominal site. However, there was no sign of follicle development in the breast site. Ovarian function ceased around 28 weeks after transplantation. CONCLUSION(S): Heterotopic autotransplantation of cryobanked human ovarian tissue can be a practical strategy for restoration of ovarian function after cancer treatment. As a site for transplantation, a space between the rectus sheath and the rectus muscle appeared to be effective.     

化疗对年轻卵巢恶性肿瘤患者保留生育功能手术后卵巢功能的影响

目的探讨保留生育功能手术的卵巢恶性肿瘤患者接受化疗对卵巢功能的影响。方法 1994年10月至2010年1月间保留生育功能手术的卵巢恶性肿瘤患者30例,分析化疗对其月经情况、性激素水平及生育情况的影响。并以同期因卵巢上皮交界性肿瘤行保留生育功能手术术后未接受化疗者28例为对照组。结果 30例保留生育功能手术后化疗的卵巢恶性肿瘤患者中,21例（70%）出现月经异常,其中12例（40%）发生停经,9例（30%）出现月经减少,停经出现在化疗后1～4个月[平均（2.17±0.8）个月]。发生停经的12例患者化疗结束后均恢复月经;月经恢复时间在化疗结束后2～7个月[平均（3.42±1.38）个月]。采用化疗方案为BEP方案（16例）、PVB方案（5例）、PT方案（3例）和PC方案（6例）,其发生停经的例数分别为6例、1例、0例和5例。对照组28例中,术后2例（7.14%）出现月经减少,均未出现停经。与化疗组比较,差异有统计学意义（P〈0.05）。化疗组5例停经患者停经期间黄体生成素和卵泡刺激素均明显升高,雌二醇明显降低。对照组6例术后血清性激素与术前比较,均无明显变化。化疗组30例患者中,12例有生育计划,其中4例已成功妊娠分娩;对照组14例有生育要求患者,8例成功妊娠分娩,子代均健康无畸形。化疗组中,2例死亡,28例无瘤生存;对照组全部无瘤生存。结论年轻妇女卵巢恶性肿瘤行保留生育功能的手术后化疗,可发生卵巢功能损害;其主要表现为停经或月经减少,血清促性腺激素水平升高,雌激素水平降低。化疗导致的停经是可逆的。化疗对患者的生育功能可能有一定影响,但对子代无明显致畸作用。     

卵巢功能保护物质的研究进展

由癌症导致的卵巢功能早衰(POF)现状越发严峻,卵巢保护和卵巢冻融移植是目前有望恢复生殖和内分泌功能的最理想方法,如何保护卵巢功能成为国内外学者的研究重点。这其中包括促性腺激素(GnRH)类似物、抗苗勒管激素(AMH)和血管生成素(Ang)等不同物质的探索。本文就如何保护卵巢功能进行综述。     

Ovarian stimulation for fertility preservation in an oncology patient with etonogestrel implant in place

PurposeTo describe a case of a young woman who presented for fertility preservation and underwent ovarian stimulation with an etonogestrel implant in place.MethodsA 24-year old, gravida 0, with an etonogestrel implant and newly diagnosed lower extremity sarcoma and DVT desiring oocyte cryopreservation prior to adjuvant chemotherapy and radiation. To avoid delay in her oncologic care and allow for continued use of contraception post-retrieval, the patient underwent controlled ovarian hyperstimulation (COH) without removal of the etonogestrel implant.ResultsBaseline labs included follicle-stimulating hormone 9 mIU/mL, luteinizing hormone 4.9 mIU/mL, estradiol 42 pg/mL, anti-Müllerian hormone 5.1 ng/mL, and antral follicle count greater than 40. The patient was placed on an antagonist protocol and stimulated with 125 IU Gonal-F and 75 IU Menopur. She received a total of 12 days of gonadotropin stimulation. On the day of trigger, her estradiol was 1472 pg/mL, lead follicle 21.5 mm with a total of 25 follicles measured > 12 mm. She was triggered with 5000 U hCG. She had a total of 23 oocytes retrieved, 17 of which were metaphase II and vitrified.ConclusionsCOH and successful oocyte cryopreservation can be achieved in patients with an etonogestrel implant in situ without apparent detrimental effects to oocyte yield or maturity. Due to the etonogestrel implant’s inhibitory effects on LH, it is recommended to use an hCG trigger for final oocyte maturation.     

Hormonal function after ovarian transposition to the abdominal subcutaneous fat tissue

We previously reported a new technique for ovarian transposition to the abdominal subcutaneous fat tissue (OTAFT) following hysterectomy. The purpose of this study is to assess the hormonal function after OTAFT. From 1993 to 2000, OTAFT was performed in 27 patients (group A). Forty-two women underwent hysterectomy and retained ovaries without transposition (group B). In 19 cases, bilateral oophorectomy with hysterectomy was performed, and they received a hormone replacement therapy (HRT) (group C). Serum follicle-stimulating hormone (FSH) level of patients was monitored every 2-12 months, and the time of menopause (defined as FSH >40 mIU/mL two times consecutively) was determined in groups A and B. After a median follow-up of 65 months, cumulative ovarian survival did not show significant difference between group A and group B (HR = 0.52, 95% CI = 0.17-1.16; P= 0.10). In patients who were 40 years old or younger, ovarian function declined significantly in group A compared to group B (HR = 0.29, 95% CI = 0.02-0.91; P= 0.04). However, FSH level of postmenopausal patients in group A was not different from FSH level of patients in group C, but FSH level of postmenopausal patients in group B was significantly higher than FSH level of patients in group C (P= 0.002). Although the procedure of OTAFT may somewhat affect the ovarian function, the transposed ovary in postmenopausal women presumably still secrete a small amount of estrogen which is equivalent to an estrogen level by HRT.     

Ovarian cancer patient surveillance after curative-intent initial treatment

Objective

Patient surveillance after potentially curative treatment of ovarian carcinoma has important clinical and financial implications for patients and society. The optimal intensity of surveillance for these patients is unknown. We aimed to document the current follow-up practice patterns of gynecologic oncologists.

Methods

We created four idealized vignettes describing patients with stages I-III ovarian cancer. We mailed a custom-designed survey instrument based on the vignettes to the members of the Society of Gynecologic Oncologists (SGO). SGO members were asked, via this instrument, how often they requested 11 discrete follow-up evaluations for their patients for the first 10 postoperative years after treatment with curative intent.

Results

We received 283 evaluable responses (30%) from the 943 SGO members and candidate members. The most frequently performed items for each year were office visit, pelvic examination, and serum CA-125 level. Imaging studies such as chest X-ray, abdominal-pelvic CT, chest CT, abdominal-pelvic MRI, and transvaginal ultrasound were rarely recommended. There was marked variation in the frequency of use of most tests. There was a decrease in the frequency of testing over time for all modalities.

Conclusion

This dataset provides detailed documentation of the self-reported surveillance practices of highly credentialed experts who manage patients with ovarian cancer in the 21st century. The optimal follow-up strategy remains unknown and controversial. Our survey showed marked variation in surveillance intensity. Identifying the sources of this variation warrants further research.     

Laparoscopic Ovarian Transposition Before Pelvic Cancer Treatment: Ovarian Function and Fertility Preservation

Survivors of pelvic cancer treatment live with the ramifications of pelvic radiation for many years after their cure. Several options are available to preserve ovarian function and fertility in reproductive age women undergoing pelvic radiation. Laparoscopic ovarian transposition is an under-utilized, yet fairly simple surgical procedure to relocate the ovaries away from the radiation field. Although randomized-controlled trials on the outcomes of ovarian transposition are scarce, there is a growing body of evidence on the risks and benefits of this procedure, in terms of prevention of premature ovarian failure, and potentially preserving fertility. In this review, we summarize the available data on the indications, patient selection and outcomes of ovarian transposition, as well as illustrate the technique of the procedure.     

卵巢囊肿与多囊卵巢皮质中卵泡密度分析及其冷冻保存

目的:探索来自卵巢囊肿及多囊卵巢综合征(polycystic ovary syndrome,PCOS)卵巢皮质中卵泡的分布特征,并观察冷冻对卵巢组织形态学的影响。方法:收集23例卵巢囊肿(卵巢囊肿组)及8例PCOS(PCOS组)的卵巢皮质,分析卵巢皮质中的卵泡密度;同时冷冻部分组织,观察冷冻前后各级卵泡的分布及形态学改变。结果:PCOS组中的卵泡密度明显高于卵巢囊肿组,但各卵泡囊肿组间的卵泡密度差异无显著性。冷冻后各组中卵泡分布以及形态正常的始基与初级卵泡比例,与冷冻前比较差异无显著性;而冷冻前后PCOS组织中初级卵泡比例显著高于卵巢囊肿组,形态正常的始基卵泡比例明显低于卵巢囊肿组。结论:卵巢囊肿与PCOS患者的卵巢皮质可作为人卵巢组织冷冻保存的标本来源。     

Transplantation of cryopreserved ovarian tissue in a patient affected by metastatic struma ovarii and endometriosis

In this case report, the outcomes of cryopreserved ovarian tissue transplantation performed in a patient affected by struma-ovarii associated with mature cystic teratoma, recurrent endometriotic cysts and diffuse peritoneal malignant struma-ovarii implants were described. Before cryopreservation, the patient underwent two left ovarian surgeries for enucleation cysts 8?years after righ salpingo-oophorectomy for struma-ovarii. Ovarian biopsy was collected in another hospital and transported to our laboratory for cryopreservation. The patient was submitted to radioiodine-therapy for metastases from malignant struma-ovarii. After treatment she experienced premature ovarian failure. Ten years after cryopreservation, a first orthotopic transplantation was performed in the left ovary and in a peritoneal pocket. Before transplantation, ovarian samples were analyzed to assess neoplastic contamination and tissue quality. Three years later, a second transplantation was heterotopically performed in abdominal subcutaneous sites. The analysis on thawed ovarian tissue did not reveal micrometastasis and they showed follicle and stroma damages. After transplantation few small follicles were observed at ultrasound examination and hormonal levels remained at menopausal values. To date no ovarian function recovery has been observed. The report highlights that ovarian tissue cryopreservation after multiple ovarian surgery may have some limitations. An accurate counseling should be offered to patients who wish to preserve fertility.