早期宫颈癌卵巢移位术

卵巢移位术是用于妇女在盆腔放射治疗 [体外照射和(或 )腔内照射 ]前将卵巢移位于放射野以外部位以保存卵巢功能的手术方法。　　卵巢为妇女性腺器官 ,它在性激素代谢和分泌中起着重要作用 ,而且还有其他重要的内分泌功能。年轻妇女因某种原因丧失了卵巢功能后 ,不仅出现人工绝经症状 ,而且由于内分泌失调尚可导致心血管与基础代谢病变。绝经前宫颈癌患者行盆腔放疗将导致卵巢功能丧失 ,随着子宫颈癌检查方法 (细胞学、阴道镜等 )的普及 ,年轻早期宫颈癌患者的数量增加 ,而且由于医学的进步使宫颈癌治愈率提高 ,平均寿命延长 ,因此治疗时不…     

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。     

年轻宫颈癌患者卵巢移位临床效果初步分析

目的　探讨宫颈癌患者卵巢移位术的临床意义。方法　收集 1 999年 9月～ 2 0 0 2年 1月间北京大学人民医院妇科收治的 1 4例绝经前患者在手术治疗的同时行卵巢移位术的临床资料 ,分析术后患者的更年期症状 ,并与临床特征进行比较。结果　① 1 4例患者均为绝经前 ,平均年龄 37 36岁 (2 7～ 4 3岁 ) ,宫颈原位癌累腺 2例、Ia 3例、Ib7例、Ⅱa2例 ;② 1 4例患者中 ,双侧卵巢移位术 6例 ,随访 8 3个月 ,5例未出现更年期症状 ;单侧卵巢移位 8例 ,4例无更年期症状 ;③术后辅助治疗 6例 ,均为宫颈浸润癌术后辅助放疗和 /或化疗 ,其中 5例分别于术后 6～ 1 8个月出现更年期症状 ,术后未辅助治疗 8例 ,其中 1例 (4 3岁 )于术后 6个月出现更年期症状。结论　宫颈癌患者术中行卵巢移位术 ,可保留卵巢的功能 ,但术后辅助放疗仍直接影响卵巢的功能 ,卵巢移位术的临床价值 ,有待进一步探讨     

宫颈癌卵巢移位术

卵巢移位术是用于妇女在盆腔放射治疗前将卵巢移位于放射野以外部位以保存卵巢功能的手术方法。它能够使宫颈癌放射治疗后继续保存卵巢功能，从而免除因内分泌功能紊乱所带给病人的痛苦，使治疗后的日常生活障碍减少到最低限度，提高生存质量。本文对宫颈癌卵巢移位术和盆腔放疗后卵巢功能，宫颈癌卵巢转移，移位的卵巢功能与卵巢照射剂量和卵巢位置的关系、宫颈癌卵巢移位术的年龄、部位、方法和并发症等问题作一简要综述。     

年轻宫颈癌患者卵巢功能的保留

流行病学调查显示,宫颈癌的发病呈年轻化趋势,同时宫颈癌患者生存率有明显改善,多数患者在诊断和治疗后长期生存,因此宫颈癌患者功能保留问题逐渐成为研究热点。现代临床医学及生殖医学发展为宫颈癌患者卵巢功能保留提供了各种方法。宫颈癌患者卵巢在体保留是目前临床应用的主要手段,卵巢体外保留仍处于研究阶段,近年取得一系列标志性成果。无论是卵巢的在体或体外保留仍存在着诸多的局限。     

年轻宫颈癌患者卵巢功能的保留

流行病学调查显示,宫颈癌的发病呈年轻化趋势,同时宫颈癌患者生存率有明显改善,多数患者在诊断和治疗后长期生存,因此宫颈癌患者功能保留问题逐渐成为研究热点.现代临床医学及生殖医学发展为宫颈癌患者卵巢功能保留提供了各种方法.宫颈癌患者卵巢在体保留是目前临床应用的主要手段,卵巢体外保留仍处于研究阶段,近年取得一系列标志性成果.无论是卵巢的在体或体外保留仍存在着诸多的局限.     

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。     

年轻宫颈癌患者卵巢移植和卵巢移位术研究

目的 探讨年轻早期子宫颈癌患者卵巢移植和移位手术效果。方法 ２６例中２例行卵巢移植术,２４例行卵巢移位术。结果 卵巢移植者,术后９￣１５个月功能恢复正常。卵巢移位者组,术后未接受放疗的９例患者卵巢功能正常,卵巢功能平均持续６．２４年;１５例术后辅以放疗,１４例保持卵巢功能,卵巢功能平均持续４．５年。     

宫颈癌患者卵巢移位术及阴道延长术后生理功能随访分析

目的:通过对早期宫颈癌患者自体卵巢移位术及阴道延长术后2年卵巢功能及性生活质量的随访,探讨卵巢移位术及阴道延长术的临床价值.方法:对45例宫颈癌患者,在行宫颈癌根治术同时行卵巢移位术和阴道延长术,术前、放疗后、术后6个月、术后1年、术后2年,行阴道细胞学检查、微粒子化学发光法血清性激素测定、B超检测、阴道长度测量,随访术后2年卵巢功能及性生活质量.结果:45例中有4例卵巢移位术后2年出现卵巢功能减退,保留卵巢功能的有效率为91.1%.同时行阴道延长术者共12例,随访至术后2年均性生活满意.未行阴道延长术的33例患者随访至术后2年,性生活欠满意27例,性生活困难6例.结论:宫颈癌患者根治术中行卵巢移位术加阴道延长术,可保留卵巢功能,提高患者术后性生活质量.     

卵巢移位对宫颈癌放疗患者卵巢功能保护作用的观察

目的:观察卵巢移位手术对宫颈癌放疗患者卵巢功能的保护及放疗对移位卵巢功能的影响.方法:对眉山市人民医院2005年10月至2009年1月期间的48例宫颈癌(Ⅰ B～ⅡA期)患者行广泛性全子宫切除加盆腔淋巴结清扫加卵巢结肠旁沟侧方移位术,有34例患者术后4周行盆腔大野照射.分别于术后、放疗后随访患者有无绝经期症状,并测定血清中卵泡刺激素(FSH)和雌二醇(E2)水平以判定卵巢功能.结果:患者术后激素水平与术前相比,差异无统计学意义(P>0.05);放疗后10个月激素水平与术前相比,差异无统计学意义(P>0.05).结论:Ⅰ B～ⅡA期宫颈癌患者行卵巢移位手术对卵巢功能无明显影响,同时可避免盆腔放疗引起卵巢功能减退.     

宫颈鳞癌卵巢悬吊术后辅助放化疗对卵巢功能影响研究

目的 探讨宫颈鳞癌患者行卵巢悬吊术后辅助放化疗对卵巢功能的影响。方法 收集2008-2014年中国医科大学附属盛京医院收治的308例ⅠA~ⅡA期宫颈鳞癌行广泛性子宫切除术+盆（腹）腔淋巴清扫术+卵巢悬吊术的患者资料,按年龄（≥40岁和＜40岁）、悬吊卵巢的数量（单侧和双侧）、术后是否辅助治疗（辅助化疗、辅助放疗、辅助放化疗）分组。随访患者术后6个月情况,采用改良的围绝经期综合征量表（改良Kupperman评分表）评分,观察其卵巢功能受损症状出现情况。结果 按年龄、悬吊卵巢的数量分组之间改良Kupperman评分比较差异均无统计意义（P>0.05）。手术+放疗组、手术+放化疗组分别与手术组间改良Kupperman评分比较、手术+放疗组与手术+化疗组间改良Kupperman评分比较,差异均有统计学意义（P<0.05）。手术+化疗组与手术组,手术+化疗组与手术+放化疗组,手术+放疗组与手术+放化疗组之间改良Kupperman评分比较差异均无统计学意义（P>0.05）。结论 宫颈鳞癌行卵巢悬吊术患者术后辅助放疗或放化疗易影响卵巢的内分泌功能。年龄、悬吊卵巢的数量及术后辅助化疗与卵巢功能是否受损可能无关。     

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.     

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.     

Survival and prognostic factors in early-stage epithelial ovarian carcinoma treated with taxane-based adjuvant chemotherapy

The present study was undertaken with the question about the outcome (recurrence-free survival, [RFS]) after adjuvant chemotherapy with taxane and carboplatin in the early stages of epithelial ovarian cancer after primary surgery. Treatment-related toxicity was also evaluated. A total of 113 patients were included in this study. The 5-year RFS rate for all 113 patients treated with adjuvant chemotherapy including taxane and carboplatin after primary surgery was 79%. The 5-year RFS rate for 85 patients in FIGO stage I was 85% and for 18 patients in FIGO stage II, it was 44%. For clear-cell carcinomas, the RFS was 87%. In univariate analysis, recurrent disease was associated with both FIGO stage and tumor grade, but in multivariate logistic regression analysis of prognostic factors for tumor recurrences, only FIGO stage (stage I versus stage II) was a significant and independent prognostic factor. However, an odds ratio (OR) of 1.9 for tumor grade (grade 3 versus grades 1-2) demonstrated two times increased risk for recurrence in a patient with a grade 3 tumor compared with grade 1-2 tumors. Furthermore, an OR of 0.39 for lymph node sampling versus no sampling meant 61% reduced risk for recurrence for a patient who had undergone lymph node sampling at surgical staging laparotomy. The major toxicities in the present study were myelosuppression (46%) and neurotoxicity (34%). Despite the use of prophylaxis, severe paclitaxel-related hypersensitivity occurred in three patients (3%).     

Gene set-based analysis of mucinous ovarian carcinoma

Objective

Mucinous ovarian carcinoma (MOC) is an uncommon subtype of epithelial ovarian cancers, and the pathogenesis is still poorly understood because of its rarity. We conducted a gene set-based analysis to investigate the pathogenesis of MOC by integrating microarray gene expression datasets based on the regularity of functions defined by gene ontology or canonical pathway databases.