卵巢恶性肿瘤患者保留生育功能治疗后的妊娠问题

近年来,保留卵巢恶性肿瘤患者的生育功能已经成为了一个重要的焦点问题,原因有以下几个方面:生育年龄患者的卵巢恶性肿瘤并非罕见;随着卵巢恶性肿瘤治疗上的进步,癌症患者的存活率有了明显提高;全球妇女准备受孕的时间越来越晚,越来越多的妇女将她们的第一次生育拖延至35~45岁;卵巢恶性肿瘤的主要治疗方法是切除子宫和卵巢以及化疗,而这些治疗方法会导致患者丧失生育能力,或即使患者保留子宫和卵巢,若接受化疗或放疗,也有可能会增加随后妊娠并发症的风险,如早期流产、早产或低出生体重儿等。为此,本文对卵巢恶性肿瘤患者保留生育功能的可行…     

卵巢恶性肿瘤年轻患者保留生育功能手术的效果评价

目的总结评价卵巢恶性肿瘤年轻患者保留生育功能手术和术后辅助化疗的效果及对生育功能及卵巢功能的影响.方法回顾性分析四川大学华西第二医院1989-2004年收治的64例接受保留生育功能手术治疗的卵巢恶性肿瘤年轻患者的临床资料.结果初诊时患者中位年龄为20（7～30）岁.64例患者中,卵巢上皮性癌患者22例,恶性生殖细胞肿瘤38例,性索间质肿瘤4例.首次手术方式如下：单侧附件切除术23例;单侧附件切除＋大网膜切除＋阑尾切除术10例,单侧附件切除＋大网膜切除＋阑尾切除＋盆腔淋巴结切除或取样术10例;单侧附件切除＋肿瘤细胞减灭术4例;单侧附件切除＋对侧卵巢楔形切除活检术11例;6例仅行患侧肿瘤剥除术.64例患者平均随访76（5～192）个月,5例（8%）死亡,59例（92%）存活至今,其中卵巢恶性生殖细胞肿瘤患者存活率为89%（34/38）,上皮性癌患者为95%（21/22）,性索间质肿瘤患者全部健在（4/4）.15例患者行二次手术,其中发现癌灶者6例.生存病例中53例患者有月经,除2例周期缩短外,其余患者月经均正常.20例有生育计划的患者中,13例（65%）患者有15次妊娠,9次足月分娩.结论对卵巢恶性生殖细胞肿瘤患者,无论期别如何,行保留生育功能手术是可行的;对于卵巢上皮性癌患者行保留生育功能手术需慎重,仅限于年轻、有强烈生育要求、肿瘤为Ⅰ期、高分化且术后有条件密切随访的患者;坚持规范化疗对卵巢恶性肿瘤的治疗十分必要;化疗对卵巢及生育功能无明显影响.     

卵巢恶性肿瘤保留生育功能的中国专家共识（2022年版）

1 背景 卵巢恶性肿瘤患者中育龄期女性约占12%［1］,在全球范围内,每年15～40岁年龄段女性新增卵巢恶性肿瘤约38 500例［2］。近年来,随着诊疗手段的不断进步,卵巢恶性肿瘤死亡率呈下降趋势［3］。年轻卵巢恶性肿瘤尤其是有生育需求的群体,除关注肿瘤治疗结局外,生活质量和保留生育能力也不容忽视。     

术后化疗对卵巢恶性肿瘤患者的卵巢功能损伤的临床分析

目的　探讨恶性卵巢肿瘤保留生育功能手术的术后化疗对卵巢功能及胎儿的影响。方法　回顾性分析日本独协医科大学 1 990年 1月～ 1 998年 1月间收治的 9例保留生育功能手术、术后化疗的恶性卵巢肿瘤患者的临床资料结果。结果　除 1例Ⅳ期卵巢无性细胞瘤死亡外 ,其余 8例均健在 ,存活时间为 2年 1 0个月～1 1年 2个月。结婚 5例中有 4例已经妊娠分娩 ,健康婴儿 6人 ,自然流产 1例 ,人工流产 1例。 9例患者中 6例月经正常 ,其中 5例基础体温呈双相 ,黄体生成激素 (LH)、卵泡刺激素 (FSH)值均正常 ,1例化疗期间月经初潮 ;3例LH ,FSH值升高出现停经 ,分别于化疗后 2、 4、 1 2个月恢复月经来朝 ,LH ,FSH值恢复正常 ,基础体温呈双相。结论　在早期恶性卵巢肿瘤特别是卵巢生殖细胞恶性肿瘤 (包括晚期 )的手术治疗中 ,保留生育功能的手术并辅以术后化疗 ,疗效肯定 ;化疗对卵巢功能的损伤是可逆的 ,对胎儿一般无致畸作用     

妇科恶性肿瘤保留生育功能肿瘤结局

子宫颈癌、卵巢癌和子宫内膜癌是妇科常见的恶性肿瘤，近年发病有年轻化趋势。对于有生育要求的年轻患者，如何在不增加肿瘤风险的情况下，保留患者术后的生育功能，成为近年来备受关注的问题。文章对保留生育功能的妇科恶性肿瘤患者的肿瘤结局进行阐述。     

卵巢恶性生殖细胞肿瘤保留生育功能治疗及其价值评估

文章就卵巢生殖细胞肿瘤的发病特点和生物学特征进行阐述,探讨卵巢恶性生殖细胞肿瘤与上皮性卵巢癌在治疗原则和方法上的异同,以及保留生育功能手术对患者预后的影响,术后化疗对卵巢功能、生育功能和后代的影响等问题,强调卵巢生殖细胞肿瘤保留生育功能的可行性。     

保留生育功能手术对卵巢交界性肿瘤临床治疗效果的影响

目的评价保留卵巢功能手术对卵巢交界性肿瘤术后复发与生育情况的影响.方法回顾性总结1981-2005北京妇产医院收治的40岁以下卵巢交界性肿瘤施行保留生育功能手术的122例术后生存期、复发率和生育状况.结果 (1)复发率:保留生育功能手术组的复发率8.2%,非保留生育功能手术组的复发率3.3%,差异有显著性(P＜0.05).(2)保留生育功能手术组没有肿瘤相关死亡,非保留生育功能手术组有1例.但两组差异无显著性.(3)保留生育功能手术组中有29例次成功妊娠.(4)中位随访时间分别为59.3个月和52.8个月.结论对年轻的卵巢交界性肿瘤患者保留生育功能手术虽然会增加复发率,但不影响生存期,且保留了生育功能,提高了生存质量.     

妇科恶性肿瘤保留生育功能的治疗进展

随着医学技术发展的日新月异,妇科恶性肿瘤保留生育功能治疗的指征亦随之拓宽,治疗的方法也不断更新.本文就妇科恶性肿瘤保留生育功能治疗的适应证、治疗方法、注意事项以及治疗过程中出现的各种问题与处理进展进行了综述.     

早期卵巢上皮性癌保留生育功能治疗

随着肿瘤发病年龄的年轻化，如何保留肿瘤患者生育功能已成为肿瘤治疗中的热点问题。卵巢癌是最常见的妇科恶性肿瘤之一，育龄期早期卵巢上皮性癌患者保留生育功能治疗日益受到关注。文章对早期卵巢上皮性癌患者保留生育功能相关问题进行阐述。     

年轻非良性卵巢肿瘤患者保留生育功能57例临床分析

目的分析年轻非良性卵巢肿瘤患者保留生育功能治疗的现状及复发情况。方法选择2000年1月至2010年4月北京大学人民医院收治的年龄≤40岁、未完成生育功能、因交界性或恶性卵巢肿瘤行保留生育功能治疗的患者57例,分析临床资料并随访肿瘤的复发情况。结果在57例患者中,交界性卵巢上皮性肿瘤38例（66.7%）,恶性生殖细胞肿瘤17例（29.8%）,其他类型2例;肿瘤分期Ⅰ期49例（86.0%）,Ⅱ期2例,Ⅲ期6例;单侧附件切除手术者33例（57.9%）,行分期手术者17例（29.8%）;化疗29例（50.9%）。成功随访42例,中位随访时间40.5个月（10～119个月）。恶性肿瘤患者无复发;交界性肿瘤患者中,8例复发,复发率25.0%。交界性肿瘤复发组（8例）和非复发组（24例）患者中位无瘤生存时间分别为21.5个月和40.5个月（P〈0.01）。微乳头结构是交界性浆液性卵巢肿瘤患者复发的危险因素（P〈0.05）。结论≤40岁、未完成生育功能的非良性卵巢肿瘤患者中以交界性肿瘤最常见;目前保留生育功能的治疗存在不同程度的问题;但肿瘤本身的特点是影响复发的主要因素。     

交界性卵巢肿瘤保留生育功能治疗方法进展

保留生育功能的手术治疗是交界性卵巢肿瘤(borderline ovarian tumors,BOTs)年轻患者保留生育能力的最佳治疗手段。保留生育功能的手术不仅对早期BOTs患者较安全,对于晚期有卵巢外种植的患者,若病灶可完全摘除,也可接受此种手术治疗。术后妊娠率可观,且大部分可通过自然方式妊娠。术后妊娠对病程影响较小,妊娠并发症也很少发生。早期BOTs患者术后不孕可给予促排卵药物治疗,但晚期患者则需要谨慎对待。若病变累及双侧卵巢不宜进行保守性手术,可选择胚胎冻存、卵母细胞冻存、卵巢组织冻存、接受卵母细胞赠送等方法。     

年轻子宫内膜癌女性保留生育及卵巢功能的治疗进展

子宫内膜癌（endometrial carcinoma,EC）是女性生殖系统三大恶性肿瘤之一,年轻育龄期EC患者相对少见,但随着子宫内膜癌发病率的逐渐上升,以及现代生活习惯的改变,EC出现明显年轻化趋势。EC的标准治疗方案使得女性永久性失去生育功能以及绝经前女性提前进入更年期,严重影响年轻患者的生活质量。故年轻EC患者保留生育功能或保留卵巢功能的治疗方案逐渐受到重视。现有的保留生育功能方案主要有：孕激素、芳香化酶抑制剂、二甲双胍等药物治疗以及宫腔镜下EC病灶切除术。多项研究已经证实,肥胖与EC发生发展相关,保留生育功能治疗期间体质量管理同样也至关重要。现就年轻EC女性保留生育及卵巢功能治疗以及治疗期间体质量管理等的研究进展进行综述。     

北京地区卵巢恶性肿瘤发病相关因素分析

目的:了解近年北京地区卵巢恶性肿瘤及其组织类型的相关因素,为预防提供依据.方法:对北京市18区(县)302例经手术病理确诊的卵巢恶性肿瘤患者和906例按年龄和地区匹配的健康对照进行问卷调查.结果:北京地区卵巢恶性肿瘤平均发病年龄51.63±14.44岁.多因素分析显示一、二级血亲卵巢癌家族史,不孕症,月经初潮年龄早(<13岁)和未采用避孕措施为卵巢恶性肿瘤的危险因素.浆液性卵巢癌的危险因素为一、二级血亲患卵巢癌家族史,累计哺乳时间短;黏液性卵巢癌的危险因素为未生育、糖尿病史、使用激素替代;其他卵巢恶性肿瘤的危险因素为未生育,一、二级血亲卵巢癌家族史,不孕症.结论:卵巢恶性肿瘤与遗传、排卵次数、生活方式等多因素相关,不同组织类型卵巢恶性肿瘤具有不同的相关因素.对于卵巢恶性肿瘤的高危人群,应加强监测,提高早期卵巢恶性肿瘤的检出,积极采取相应的预防措施,将有助于降低卵巢恶性肿瘤的死亡率.     

Fertility Preservation in Reproductive Age Women with Cancer

Cancer may be detected at any age and could affect children, and reproductive age women as well. In recent years, cancer treatment has become less destructive and more specific. As a result, survival rates and quality of life following successful treatment have continuously improved. Cancer treatment typically involves surgery, chemo- or radiation therapy, or the combinations of these. These interventions often adversely affect the function of the reproductive organs. Chemo- and radiation therapy are known to be gonadotoxic. Survivors of oncologic therapy are typically rendered infertile primarily due to the loss of ovarian function. There are, however, several medical, surgical, and assisted reproductive technology options that could be and should be offered to those diagnosed with cancer and wish to maintain their fertility. Embryo cryopreservation has been available for decades and has been successfully applied for fertility preservation in women diagnosed with cancer. Recent advances in cryobiology have increased the efficacy of not just embryo but even oocyte and ovarian tissue freezing–thawing. Oocyte vitrification just like embryo cryopreservation requires the use of stimulation but does not require the patient to be in a stable relationship or accept the use of donor sperm. Ovarian tissue cryopreservation does not require stimulation and, following successful transplantation, provides the patient with the most eggs but is currently still considered experimental. This paper summarizes the various fertility-sparing medical, surgical and assisted reproductive technology options. It reviews the current status of embryo, oocyte, and ovarian tissue cryopreservation and discusses their risks and benefits.     

Oocyte Cryopreservation for Fertility Preservation in Postpubertal Female Children at Risk for Premature Ovarian Failure Due to Accelerated Follicle Loss in Turner Syndrome or Cancer Treatments

ObjectiveTo preliminarily study the feasibility of oocyte cryopreservation in postpubertal girls aged between 13 and 15 years who were at risk for premature ovarian failure due to the accelerated follicle loss associated with Turner syndrome or cancer treatments.DesignRetrospective cohort and review of literature.SettingAcademic fertility preservation unit.ParticipantsThree girls diagnosed with Turner syndrome, 1 girl diagnosed with germ-cell tumor. and 1 girl diagnosed with lymphoblastic leukemia.InterventionsAssessment of ovarian reserve, ovarian stimulation, oocyte retrieval, in vitro maturation, and mature oocyte cryopreservation.Main Outcome MeasureResponse to ovarian stimulation, number of mature oocytes cryopreserved and complications, if any.ResultsMean anti-müllerian hormone, baseline follical stimulating hormone, estradiol, and antral follicle counts were 1.30 ± 0.39, 6.08 ± 2.63, 41.39 ± 24.68, 8.0 ± 3.2; respectively. In Turner girls the ovarian reserve assessment indicated already diminished ovarian reserve. Ovarian stimulation and oocyte cryopreservation was successfully performed in all female children referred for fertility preservation. A range of 4-11 mature oocytes (mean 8.1 ± 3.4) was cryopreserved without any complications. All girls tolerated the procedure well.ConclusionsOocyte cryopreservation is a feasible technique in selected female children at risk for premature ovarian failure. Further studies would be beneficial to test the success of oocyte cryopreservation in young girls.     

28例复发性卵巢内胚窦瘤的临床治疗分析

目的 :总结复发性卵巢内胚窦瘤化疗和手术治疗的临床经验 ,分析其与预后的关系。方法 :回顾性分析1980年 1月至 2 0 0 0年 12月在我院收治的复发性卵巢内胚窦瘤 2 8例 ,复发后 2 5例行再次肿瘤细胞减灭术 ,2 8例患者均接受化疗。结果 :2 8例患者中 11例存活 (39.3% )。复发后应用PVB或PEB方案的 18例患者存活 10例 (5 5 .6 % ) ;应用其他化疗方案的 10例患者存活仅 1例 (10 % ) ,两者比较差异有显著性 (P <0 .0 5 )。应用PVB或PEB≥ 6疗程患者的生存率与 <6疗程者相比差异无显著性。结论 :卵巢内胚窦瘤复发后应尽可能行再次肿瘤细胞减灭术 ,选择PVB或PEB方案为术后辅助化疗方案的治疗效果较好     

青少年卵巢肿瘤的临床病理分析

目的:探讨青少年卵巢肿瘤的临床病理特点。方法:回顾性分析67例20岁以下的青少年卵巢肿瘤患者的临床表现、诊断、病理和治疗。结果:临床症状以腹痛、腹部包块为主,肿瘤扭转率高。良性肿瘤41例,交界性3例,恶性23例;组织学类型以生殖细胞肿瘤最多。恶性肿瘤中65.2%为FIGOI期。除8例恶性患者进行了肿瘤细胞减灭术外,其余59例均进行了保留生育功能的手术。15例恶性肿瘤患者术后化疗。单因素分析显示仅化疗方案影响生存期,BEP优于VAC。结论:青少年卵巢肿瘤的临床病理特点与成人不同,首选保留生育功能的手术,BEP是恶性患者的一线化疗方案。     

Fertility preservation in men with cancer

Due to recent advances in medical technologies, cancer has become more curable and chronic, and post-treatment quality of life, including male fertility, has become an important issue. Cancer itself can affect spermatogenesis through complex interactions, and cancer treatment such as surgery, radiotherapy and chemotherapy, all have certain detrimental effects on spermatogenesis. Currently, sperm cryopreservation before cancer treatment is the mainstay of fertility preservation, and is recommended by numerous guidelines. Although fertility preservation should be discussed with all cancer patients before treatment, it still remains underused. Postpubertal patients who are unable to bank sperm may undergo testicular sperm extraction before treatment. For prepubertal boys, there is no clinically established guideline for fertility preservation. Investigations such as spermatogonial stem cell culture are ongoing, and may lead to clinical options for fertility preservation in the future.     

Fertility Preservation in Women with Turner Syndrome: A Comprehensive Review and Practical Guidelines

In this article we review the existing fertility preservation options for women diagnosed with Turner syndrome and provide practical guidelines for the practitioner. Turner syndrome is the most common sex chromosome abnormality in women, occurring in approximately 1 in 2500 live births. Women with Turner syndrome are at extremely high risk for primary ovarian insufficiency and infertility. Although approximately 70%-80% have no spontaneous pubertal development and 90% experience primary amenorrhea, the remainder might possess a small residual of ovarian follicles at birth or early childhood. The present challenge is to identify these women as early in life as is possible, to allow them to benefit from a variety of existing fertility preservation options. To maximize the benefits of fertility preservation, all women with Turner syndrome should be evaluated by an expert as soon as possible in childhood because the vast majority will have their ovarian reserve depleted before adulthood. Cryopreservation of mature oocytes and embryos is a proven fertility preservation approach, and cryopreservation of ovarian tissue is a promising technique with a growing number of live births, but remains investigational. Oocyte cryopreservation has been performed in children with Turner syndrome as young as 13 years of age and ovarian tissue cryopreservation in affected prepubertal children. However, current efficacy of these approaches is unknown in this cohort. For those who have already lost their ovarian reserve, oocyte or embryo donation and adoption are strategies that allow fulfillment of the desire for parenting. For those with Turner syndrome-related cardiac contraindications to pregnancy, use of gestational surrogacy allows the possibility of biological parenting using their own oocytes. Alternatively, gestational surrogacy can serve to carry pregnancy resulting from the use of donor oocytes or embryos, if needed.