腹腔镜手术对卵巢良性肿瘤创伤指标及卵巢功能的影响

目的探讨腹腔镜手术对卵巢良性肿瘤创伤及卵巢功能的影响。方法选取卵巢良性肿瘤患者120例,按门诊号编号,采用随机数字法分为观察组和对照组,每组60例。对照组实施开腹手术治疗,观察组实施腹腔镜手术治疗。比较两组患者围手术期相关指标,术后创伤指标及雌二醇(E2),促卵泡雌激素(FSH),促黄体素(LH)等卵巢功能检查指标水平变化。结果观察组术中出血量、手术时间、术后镇痛率与对照组相比均有统计学意义(P<0.05),而术后排气时间与对照组相比差异无统计学意义(P>0.05)。观察组患者治疗后WBC、CRP、IL-6与对照组相比,差异有统计学意义(P<0.05),而TNF-Α与对照组相比差异无统计学意义(P>0.05)。观察组患者治疗前后E2、FSH、LH水平变化不显著,差异无统计学意义(P>0.05),但治疗后1、3、6个月与对照组比较均有统计学意义(P<0.05)。结论腹腔镜手术治疗卵巢良性肿瘤对患者机体创伤影响较小,恢复较好,且不会对卵巢功能造成显著影响。     

腹腔镜卵巢囊肿剔除术中不同止血方式对卵巢功能的影响

目的比较腹腔镜卵巢囊肿剔除术中不同止血方式对卵巢功能的影响。方法 106例卵巢囊肿患者根据腹腔镜卵巢囊肿剔除术中止血方式分为缝合组(n=56)和电凝组(n=50),术后进行6个月的随访,观察两组患者月经和排卵情况及激素水平,并行彩超检查患者卵巢间质动脉血流收缩期峰值流速(PSV)、窦卵泡数及卵巢大小。结果缝合组患者恢复排卵的比例为82.1%,明显高于对照组的64.0%,差异有统计学意义(P<0.05)。术后6个月,缝合组患者血清促卵泡成熟激素(FSH)、促黄体生成素(LH)、雌二醇(E2)水平与术前比较,差异无统计学意义(P>0.05);但电凝组术后6个月的FSH及LH水平明显高于术前,E2明显低于术前,与缝合组差异均有统计学意义(P<0.05)。电凝组患者窦卵泡数较术前明显减少,且明显低于缝合组,差异有统计学意义(P<0.05)。结论腹腔镜卵巢囊肿剔除术中采用缝合止血比电凝止血法更有利于保护患者的卵巢功能。     

腹腔镜和开腹手术治疗卵巢良性肿瘤的疗效及对免疫功能的影响

目的探讨腹腔镜手术和开腹手术治疗卵巢良性肿瘤的临床效果及对免疫功能的影响。方法选择2011年6月至2012年5月收治的114例卵巢良性肿瘤患者作为研究对象,其中采用传统开腹手术治疗的55例患者作为对照组,采用腹腔镜手术治疗的59例患者作为观察组,比较两组患者的临床效果及对免疫功能的影响。结果观察组的术中出血量明显少于对照组,术后排气时间及住院时间明显短于对照组,组间差异有统计学意义(P<0.05)。观察组患者的并发症发生率为3.4%,略低于对照组的5.5%,组间差异无统计学意义(P>0.05)。观察组雌二醇(E2)、黄体生成素(LH)和促卵泡激素(FSH)改善更为明显,与对照组比较,差异均具有统计学意义(P<0.05)。观察组患者的血清免疫球蛋白IgA、IgG、IgE改善情况明显优于对照组,组间差异有统计学意义(P<0.05)。结论腹腔镜手术治疗卵巢良性肿瘤能够更好地改善患者的卵巢功能,患者恢复快并且安全性可靠,同时能够明显保护患者的免疫功能,是临床首选的治疗方案。     

不同手术方案对子宫肌瘤患者卵巢储备功能的影响

目的探讨不同手术方案对子宫肌瘤患者卵巢储备功能的影响。方法选取2014年1月至2015年1月间接受手术治疗的子宫肌瘤患者150例,按照随机数字表法分为腹腔镜下子宫全切除组、腹腔镜下子宫次全切组和开腹组,每组各50例。分析各组患者的手术时间、术中出血量以及术前、术后1个月、术后2个月促卵泡成熟激素(FSH)、雌二醇(E2)的水平。结果腹腔镜下全切组患者手术时间为102.3 min,术中出血量为(123.6±3.2)ml;腹腔镜下次全切组患者手术时间为120.2 min,术中出血量为(105.4±4.1)ml;开腹组患者手术时间为72.3 min,术中出血量为(150.3±2.1)ml,各组患者的手术时间和术中出血量等方面差异有统计学意义(P<0.05)。术后1个月,各组患者FSH水平值均显著降低,且差异有统计学意义(P<0.05);术后1个月,各组患者E2水平值显著降低,且差异有统计学意义(P<0.05);但术前、术后2个月E2水平差异无统计学意义(P>0.05)。结论腹腔镜下子宫次切除手术方案能够显著减少术中出血量,改善患者的卵巢储备功能。     

腹腔镜下卵巢囊肿剔除手术的应用效果

目的探讨腹腔镜下卵巢囊肿剔除手术的应用效果。方法 80例单侧良性卵巢囊肿患者,根据随机抽签法分为试验组和对照组,每组40例。对照组患者采用开腹卵巢囊肿剔除手术,试验组患者采用腹腔镜下卵巢囊肿剔除手术。结果试验组患者术中出血量、术后肛门排气时间和住院时间都显著少于对照组(P<0.05)。两组患者的术前激素水平比较,差异无统计学意义(P>0.05)。手术后两组患者的促卵泡激素(FSH)和促黄体生成素(LH)水平均明显增加,差异有统计学意义(P<0.05)。治疗后,试验组的PSV、EDV和阻力系数(RI)与对照组比较,差异无统计学意义(P>0.05)。随访3个月时,试验组的脏器损伤、肠梗阻、切口感染等并发症发生率显著低于对照组。结论腹腔镜下卵巢囊肿剔除手术是常见的微创方法,并发症少,对近期卵巢激素分泌无放大作用,不影响卵巢血管血流情况,值得临床推广。     

腹腔镜卵巢移位对年轻中晚期宫颈鳞癌患者同步放化疗后卵巢功能的影响

目的:研究腹腔镜卵巢移位对年轻中晚期宫颈癌同步放化疗后卵巢功能的影响。方法:对我院2012至2016年年轻中晚期宫颈癌进行同步放化疗的患者进行对照研究,将患者分为手术组和对照组,比较两组患者身高、体重、体重指数、术前血清促卵泡成熟激素（FSH）、黄体生成激素（LH）和雌二醇（E2）水平。首次放化疗后3、6、12个月检查患者血清中FSH、LH、E2以及Kupperman评分,比较两组患者的差异。结果:经筛选后共47例患者纳入研究,其中手术组20例,对照组27例。两组患者术前各项参数均无差异（P＞0.05）。治疗后3个月两组患者各项指标均无差异（P＞0.05）。治疗后6个月和12个月手术组患者血清FSH低于对照组（P＜0.05）,E2高于对照组（P＜0.05）,Kupperman评分低于对照组（P＜0.05）。治疗后12个月手术组患者血清LH水平低于对照组（P＜0.05）。结论:腹腔镜卵巢移位术对年轻中晚期宫颈癌同步放化疗后卵巢功能的保护具有积极作用。     

腹腔镜与开腹手术治疗卵巢良性肿瘤对患者免疫功能的影响

目的探讨腹腔镜与开腹手术治疗卵巢良性肿瘤对患者免疫功能的影响。方法2009年1月至2013年1月收治的138例卵巢良性肿瘤患者,按照治疗方法分为腹腔镜组(68例)和开腹组(70例)。比较两组患者术中出血量、术后镇痛率、术后恢复排气时间、术后并发症发生率以及免疫功能。结果腹腔镜组患者的术中出血量、术后镇痛率、术后恢复排气时间及术后并发症发生率均明显低于开腹组,差异有统计学意义(P<0.05)。腹腔镜组患者术后24h CD+3T细胞比率、CD+4T细胞比率、CD+3T/CD+4T细胞比值明显高于开腹组,差异有统计学意义(P<0.05)。腹腔镜组术后24h IgG的水平明显高于开腹组患者,差异有统计学意义(P<0.05)。结论腹腔镜手术以其创伤小、术中出血量少、术后镇痛率低等优点成为治疗卵巢良性肿瘤的重要术式,同时可以较好地保护患者机体的细胞免疫和体液免疫功能,值得临床推广应用。     

不同止血方法对腹腔镜下卵巢肿瘤剥除术后卵巢功能影响的临床对比研究

目的:探讨不同止血方法对腹腔镜下卵巢肿瘤剥除术后卵巢功能的影响。方法:本研究选择2011年5月-2013年3月我院收治的92例卵巢良性肿瘤患者,根据在腹腔镜下卵巢肿瘤剥除术中所采取的止血方法的不同将其分为观察组与对照组,观察组患者采用双极电凝止血法,对照组患者采用缝合的止血方法。 观察两组患者手术时间、出血量、住院天数、体内性激素［卵泡刺激素(FSH)、雌二醇(E2)、黄体生成素(LH)］水平及手术后月经情况的变化。结果:观察组患者的手术时间明显低于对照组,出血量及住院天数也显著性低于对照组,组间比较差异均具有统计学意义（P＜0.05);两组患者手术前性激素（FSH、E2、LH）水平进行比较无显著性差异（P＞0.05),手术后两组性激素水平比较有显著性差异（P＜0.05);观察组的月经正常率为93.5%,对照组为71.7%,观察组正常率明显高于对照组,两组比较有统计学意义（P＜0.05）。结论:采用电凝的止血方法与传统的手术缝合方法相比,前者可以有效保持卵巢的正常生理功能,降低手术对患者的副作用,值得进一步研究。     

腹膜外卵巢移位术与改良卵巢移位术对宫颈癌患者卵巢功能的影响

目的探讨腹膜外卵巢移位术与改良卵巢移位术对宫颈癌患者卵巢功能的影响。方法选取2010年3月至2015年9月间山东潍坊临朐县人民医院收治的140例宫颈癌患者,采用随机数表法将患者分为观察组和对照组,每组70例。观察组行改良卵巢移位术,对照组行腹膜外卵巢移位术。比较两组患者治疗前后孕酮(P)、卵泡刺激素(FSH)、黄体生成素(LH)及雌二醇(E)含量,并发症发生率及随访24周性生活满意度。结果两组患者治疗前P、FSH、LH及E值比较,差异均无统计学意义(均P>0.05)。两组患者治疗后较治疗前比较P值升高、FSH、LH和E值降低,但差异均无统计学意义(均P>0.05)。两组治疗后P、FSH、LH及E值比较差异无统计学意义(P>0.05)。观察组并发症发生率为10.0%,对照组并发症发生率为21.4%,观察组较对照组相比并发症发生率明显降低,差异有统计学意义(P<0.05)。对照组性生活满意率为81.4%,观察组性生活满意率为91.4%,观察组较对照组比较性生活满意明显提高,差异有统计学意义(P<0.05)。结论腹膜外卵巢移位术与改良式卵巢移位手术治疗宫颈癌都可以有效保留卵巢的功能,改良式卵巢移位术可减少并发症的发生,显著提高患者术后性生活满意度。     

腹腔镜手术治疗卵巢良性肿瘤的疗效

目的探讨腹腔镜手术治疗卵巢良性肿瘤患者的治疗效果。方法选取2016年10月至2018年10月间四川省遂宁市第一人民医院收治的96例卵巢良性癌患者作为本次研究对象,采用随机数表法分为对照组和观察组,每组48例。对照组患者采用常规开腹手术治疗,观察组患者采取腹腔镜手术治疗,比较两组患者的手术情况、卵巢功能和神经内分泌指标。结果观察组手术时间、术中出血量、住院时间和肛门排气时间等明显低于对照组,差异均有统计学意义(均P <0. 05)。手术前,两组患者雌二醇(E2)、黄体生成素(LH)和卵泡刺激素(FSH)比较,差异无统计学意义(P>0. 05)。手术后,观察组患者E2、LH和FSH指标均明显优于对照组患者,差异均有统计学意义(均P <0. 05)。手术前,两组患者胰高血糖素、β-内啡肽(β-EP)、皮质醇(COR)和促甲状腺激素(TSH)比较,差异无统计学意义(P> 0. 05)。手术后,观察组患者胰高血糖素、β-EP、COR和TSH指标明显优于对照组患者,差异均有统计学意义(均P <0. 05)。结论采用腹腔镜手术治疗卵巢良性肿瘤患者,能有效降低术中出血量,改善卵巢功能,降低应激反应,值得在临床上推广。     

miRNA与卵巢癌

卵巢癌是世界上妇科恶性肿瘤患者死亡的主要原因,严重的威胁着女性的健康.目前,临床上还没有早期特异的诊断方法和治疗方法.microRNA（miRNA）是一类对基因有调控功能的内源性非编码小分子RNA,能与靶mRNA完全或者不完全的互补配对,最终导致mRNA降解或翻译抑制,从而对基因转录后水平进行进一步调控.有研究认为,miRNA在卵巢肿瘤细胞的增殖、分化、凋亡、转移等生物学过程中都有着关键性的作用,因此可能成为卵巢癌早期检测、个体化治疗和治疗后疗效监测的有效方法.     

Measuring Ovarian Escape in Premenopausal Estrogen Receptor-Positive Breast Cancer Patients on Ovarian Suppression Therapy

PurposeThis study evaluated the proportion of premenopausal women who experience persistent ovarian escape (OE) while receiving ovarian suppression (OS) therapy for estrogen receptor‐positive (ER+) breast cancer treatment. The study also examined clinical factors that may predispose to higher risk of persistent OE.Materials and MethodsThis was a retrospective, “real‐world” study to evaluate premenopausal women receiving adjuvant endocrine OS therapy. The primary objective was to measure the percentage of persistent OE within the first 3 months of OS injections (using either leuprolide or goserelin). The secondary objective was to associate baseline clinical data (age, body mass index [BMI], and previous chemotherapy) with the probability of OE.ResultsOf the 46 patients included in this analysis, 11 (23.9%) women did not achieve OS within 3 months. Three women (6.5%) remained in OE at 12 months. Older age (odds ratio, 0.86; confidence interval, 0.76–0.98, p = .024) was associated with lower chance of developing OE. BMI, previous chemotherapy, and drug used (tamoxifen versus aromatase inhibitor) did not correlate with the likelihood of OE in this patient cohort.ConclusionAmong the premenopausal women who did not attain complete ovarian suppression, young age was a significant risk factor for likelihood of OE. Although the clinical relevance of this finding is not yet known, it should prompt further studies to determine whether inadequate OS is associated with higher recurrence risk for patients with ER+ breast cancer.Implications for PracticeBecause up to a quarter of premenopausal women do not attain adequate ovarian suppression within the first 3 months of gonadotropin‐releasing hormone (GnRH) agonist therapy, bloodwork should be checked to ascertain hormone levels prior to starting aromatase inhibitor therapy, and at regular intervals, for these women.     

小儿卵巢肿瘤及囊肿

目的：探讨小儿卵巢肿瘤及囊肿的临床症状,诊断、病理特点及治疗。方法：对１９８８～１９９７年手术治疗的４１例卵巢肿瘤及囊肿,进行总结分析。结果：良性肿瘤术后无复发,恶性６例中存活３例,结论：小儿下腹部肿块伴有或不伴有腹痛术前均应作Ｂ超明确肿块来源及性质。甲胎蛋白（α－ＦＰ）酶标检查对小儿卵巢生殖细胞源性的恶性肿瘤的诊断及预后监测起了重要的作用。对怀疑恶性卵巢肿瘤术中宜作冰冻病理切片检查以决定手术方     

Evaluation of Ovarian Cysts in Breast Cancer Cases on Tamoxifen

Purpose: The anti- estrogen drug, tamoxifen, is one of the most important medications used in the treatmentof both advanced and localized breast cancer. However, such tamoxifen use may have some risks related to theendometrium and ovaries.We followed a group of women with breast cancer on tamoxifen for the developmentof ovarian cysts. Methods: Based on a cross sectional study, 35 pre and post menopausal patients with breastcancer on tamoxifen were followed by pelvic exam and vaginal ultrasonography for 3 cycles of 3 month intervals;occurrence and outcome of ovarian cysts were evaluated. Results: Of the 35 tmoxifen-treated patients enrolledin this study, 21 were postmenopausal and 14 were premenopausal .Their average age was 48.1±8.7 (range: 29-65 yrs) years. The mean duration of tamoxifen therapy was 30.5± 14 months (range: 12-60 months). Ovariancysts were diagnosed in 12 (34.3%) patients, with surgery required in 6; pathological examination revealedmalignancy in two cases. Conclusion: Development of ovarian cysts is a rather frequent event in women withbreast cancer on tamoxifen. The majority of cysts are simple, which may resolve spontaneously or withdiscontinuation of tamoxifen, but malignancy needs to be ruled out.     

Ovarian function after ovarian transposition and additional pelvic radiotherapy: A systematic review

ObjectiveTo investigate the ovarian survival (OS) after ovarian transposition (OT) and pelvic radiation.DesignSystematic review.Electronic databases were searched to identify studies on OT prior to external beam radiation therapy (EBRT, to the pelvic). Primary outcome was the ovarian function after radiotherapy and ovarian transposition. Secondary outcomes were complication-rate. Only studies in English, German or French were included.SettingNot applicable.PatientsFertile women undergoing ovarian transposition prior to pelvic radiation therapy.InterventionsWe included all studies, containing >5 patients, treated with OT prior to radiation therapy.Main outcome measureOvarian function.ResultsOur search yielded a total of 1130 studies of which 38 were eligible with a total of 765 patients. All studies were cohort studies or case-series. Heterogeneity among studies could not be rejected hence meta-analysis could not be performed.OS after OT and EBRT ranged from 20% to 100%. The median follow-up ranged from 7 to 102 months. OS was higher after OT and brachytherapy (OS 63.6–100%) when compared to OT and EBRT (20–100%) and OT concomitant chemoradiotherapy (0–69.2%).Only 22 studies (with 112 patients) reported on complications: among these studies the complication-rate was 0%–28.6%.ConclusionFrom our systematic review of literature we conclude that the preservation of ovarian function after OT prior to EBRT is successful in 20–100% of patients. Most favorable outcome with regard to preservation of ovarian function is seen in patients after OT and BT, followed by OT and EBRT and OT and RT combined with chemotherapy.     

Prediction of Postchemotherapy Ovarian Function Using Markers of Ovarian Reserve

Background.

Reproductive-aged women frequently receive both chemotherapy and endocrine therapy as part of their treatment regimen for early stage hormone receptor-positive breast cancer. Chemotherapy results in transient or permanent ovarian failure in the majority of women. The difficulty in determining which patients will recover ovarian function has implications for adjuvant endocrine therapy decision making. We hypothesized that pretreatment serum anti-Müllerian hormone (AMH) and inhibin B concentrations would predict for ovarian function following chemotherapy.

Methods.

Pre- and perimenopausal women aged 25–50 years with newly diagnosed breast cancer were enrolled. Subjects underwent phlebotomy for assessment of serum AMH, inhibin B, follicle-stimulating hormone, and estradiol prior to chemotherapy and 1 month and 1 year following completion of treatment. Associations among hormone concentrations, clinical factors, and biochemically assessed ovarian function were assessed.

Results.

Twenty-seven subjects were evaluable for the primary endpoint. Median age was 41. Twenty subjects (74.1%) experienced recovery of ovarian function within 18 months. Of the 26 evaluable subjects assessed prior to chemotherapy, 19 (73.1%) had detectable serum concentrations of AMH. The positive predictive value of a detectable baseline serum AMH concentration for recovery of ovarian function was 94.7%, and the negative predictive value was 85.7%. On univariate analysis, younger age and detectable serum AMH concentration at chemotherapy initiation were predictive of increased likelihood of recovery of ovarian function.

Conclusion.

Prechemotherapy assessment of serum AMH may be useful for predicting postchemotherapy ovarian function. This finding has implications for decision making about adjuvant endocrine therapy in premenopausal women treated with chemotherapy.     

卵巢癌膈下病灶手术处理对预后影响的初步循证评价

目的：目价卵巢癌膈下病灶手术处理的安全性及对预后的影响。方法：检索2000年1月1日至2010年12月31日间公开发表、关于卵巢癌手术中膈肌病灶处理的文献进行初步循证评价，探讨膈肌手术的安全性及临床价值。结果：12篇文献（753例患者）符合纳入标准。最常见的手术相关并发症是胸腔积液、其次为气胸、肺炎、膈下脓肿等。仅有1例手术相关死亡。膈肌手术组手术时间为78分钟～710分钟，住院时间为4天～146天。行膈肌手术的患者达到理想肿瘤细胞减灭术的比例高于未行膈肌手术患者，预后亦较好。结论：卵巢癌膈下病灶的处理是安全可行的，能提高患者理想肿瘤细胞减灭术的比例，从而改善患者的预后，但目前多为小样本回顾性研究，有待多中心前瞻性的临床试验的研究结果加以证明。     

卵巢囊性肿瘤的附壁结节：（附5例报告）

本文报告5例卵巢囊性肿瘤(3例粘液性囊性肿瘤,2例成熟型囊性畸胎瘤)的附壁结节。按其组织学特点分为3种类型:①龈瘤型,②梭形细胞型,③组织细胞型。其共同特点是无论在大体上还是显微镜下,附壁结节与周围囊壁间有清楚的界限,组织间灶性出血及多种炎细胞掺杂。组织发生考虑为囊壁间质对出血等刺激的不同阶段的不同反应所致。     

卵巢癌一级预防研究进展

卵巢癌是严重危害女性健康的恶性肿瘤之一，其死亡率居妇科恶性肿瘤首位。目前遗传易感是卵巢癌较明确的高危因素，其他可能的因素包括激素使用、疾病/生殖相关因素及生活方式等。根据卵巢癌发生的不同风险等级，可将人群分为高风险人群和普通人群，本文就两个人群的筛查策略、干预措施两方面分别进行研究进展追踪。常规筛查不能提高普通人群卵巢癌的检出率，也无法提高卵巢癌生存。加强卵巢癌高风险人群肿瘤预防意识，进行有效筛查及干预，是降低卵巢癌发病率及死亡率的重要手段。