卵巢恶性肿瘤治疗后的生育和助孕策略

正恶性肿瘤保留生育功能的手术治疗(fertility sparing surgery,FSS)及术后的生育、助孕问题,属于肿瘤-生殖医学(onco-fertility)的范畴,是门交叉学科,涉及妇科、生殖、肿瘤、产科、儿科、伦理学。其中,卵巢恶性肿瘤的生育力保存是极具挑战性的,因为涉及重要生殖器官,且早期诊断难,易复发。目前卵巢恶性肿瘤保留生育功能治疗的主要方法有:FSS、术中或术后生育力保存技术、手术后的生育指导及辅助妊娠。卵巢肿瘤FSS是指全面分期的     

非上皮性卵巢癌的化疗

非上皮性卵巢恶性肿瘤相对较少见,发病率占卵巢恶性肿瘤的约10%,其病理形态多样,包括恶性生殖细胞来源、性索间质细胞来源、转移性卵巢癌以及一些极其罕见的卵巢癌(如肉瘤、脂肪细胞瘤等)。虽然这些肿瘤在临床表现、诊断和治疗上有很多相似之处,但由于其各有不同的特性,故在临床处理上也各有特点。与上皮性卵巢癌相似,非上皮性卵巢恶性肿瘤也以手术联合化疗为主要治疗方式。本文主要讨论各类较常见的非上皮性卵巢恶性肿瘤的化学治疗。1生殖细胞恶性肿瘤在过去的20年间,卵巢生殖细胞肿瘤的化疗方案经历了由VAC→PVB→BEP方案的演变,化疗…     

妇科恶性肿瘤生育力保护的权衡与决策

        随着女性生育年龄的普遍推迟和癌症发病年龄的年轻化，生育力保护已成为肿瘤治疗决策时经常需要面临的问题。妇科恶性肿瘤发生于女性生殖系统，任何一种根治性治疗都不可避免地会带来生育力的破坏或丧失。现代诊疗手段的进步、辅助生殖技术的应用使得妇科恶性肿瘤患者的生育力保护成为可能。妇科肿瘤医师必须充分了解患者的生育意愿，仔细权衡各种生育力保护治疗的风险与获益，从而保证良好的肿瘤结局和生育结局。     

卵巢恶性肿瘤保留生育功能后化疗的策略及卵巢保护

正卵巢恶性肿瘤的发病年龄呈现年轻化趋势,随着医学手术技巧的提高和医学理念的转变,越来越多的年轻卵巢恶性肿瘤患者,接受保留生育功能的手术治疗。这些患者大部分在术后需要进一步化疗作为辅助治疗。本文从卵巢恶性肿瘤保留生育功能术后化疗的指征、方案、疗程及卵巢保护措施等方面的最新进展进行讨论。     

子宫内膜异位症患者生育力保护的中国专家共识(2022版)

子宫内膜异位症(内异症)是育龄期妇女的常见疾病之一, 常导致患者生殖功能及卵巢储备功能降低, 因此, 在内异症诊治中应注意保护患者的生育力, 改善生殖功能。依据患者年龄、内异症病变范围、内异症生育指数、卵巢储备功能及患者意愿等因素综合制定治疗策略;术前做好评估, 术后积极备孕或辅助生殖技术;对于无生育需求者, 通过药物治疗改善症状, 控制病情进展, 做好长期管理。对于一些病情严重或复发的内异症患者, 可在术前进行生育力保存。     

卵巢非上皮性恶性肿瘤的甾体激素受体

近十年来有关卵巢上皮性癌的雌激素受体(ER)已有报道,但是对于非上皮性卵巢恶性肿瘤报道极少。育龄妇女生殖细胞恶性肿瘤的受体含量值得注意,因这涉及到是否切除对侧卵巢及用雌激素     

卵巢子宫内膜异位囊肿卵巢功能保护研究进展

卵巢子宫内膜异位囊肿是育龄期妇女子宫内膜异位症的常见表现形式,严重威胁女性生殖健康,降低患者生育力,给患者心理及经济造成重大负担。目前,卵巢子宫内膜异位囊肿仍面临着诊断延迟、疾病进展及后续治疗损伤卵巢储备功能、术后高复发率等问题,这些原因都直接或间接降低女性生育力。但临床尚无关于卵巢子宫内膜异位囊肿卵巢储备功能保护的统一标准治疗方案。从评估卵巢储备功能、卵巢子宫内膜异位囊肿早诊断及药物治疗、适合的手术方式及生育力保存方式选择、术后管理等方面,综述关于卵巢子宫内膜异位囊肿卵巢储备功能保护的最新研究进展,以期在最大程度保护卵巢储备功能的基础上,为卵巢子宫内膜异位囊肿女性选择合适的治疗方案。     

早期非上皮性卵巢恶性肿瘤腹腔镜手术的临床分析

目的:探讨早期非上皮性卵巢恶性肿瘤(MNEOT)腹腔镜手术的可行性及临床疗效。方法:回顾分析2010年1月~2014年5月在我科行腹腔镜手术的45例早期MNEOT患者的临床资料,包括颗粒细胞瘤15例,无性细胞瘤13例,未成熟畸胎瘤12例,卵黄囊瘤3例,睾丸母细胞瘤2例。17例行腹腔镜全面分期手术,28例(62.2%)行保留生育功能手术。结果:手术均顺利完成,无中转开腹和术中并发症。术后24h内均可下床活动,术后肛门排气时间(4±2)d。除IA期及拒绝化疗者外,30例术后辅助化疗,术后与开始化疗间隔(7±2)d。随访时间(27±11)月,1例IC期复发,行二次手术及化疗。无死亡。结论:腹腔镜手术治疗早期MNETO是安全、有效的。     

卵巢型子宫内膜异位症手术相关问题

卵巢型子宫内膜异位症（简称内异症）是内异症手术最常见的一种亚型，实施手术的时机以及术中卵巢功能保护备受关注。文章以卵巢型内异症患者是否有生育要求、是否复发为切入点，分层阐述临床诊治原则及手术相关问题，并强调根据手术难度分级决定由相应手术经验的医师实施，以获得手术的质控，兼顾生育力保护及手术彻底性。     

卵巢卵黄囊瘤手术和化疗后自然周期体外受精-胚胎移植成功分娩一例并文献复习

卵巢卵黄囊瘤属卵巢恶性生殖细胞肿瘤,占卵巢恶性肿瘤的1%。由于卵巢恶性生殖细胞肿瘤多见于儿童及年轻女性,故保存生育能力是关键。卵巢卵黄囊瘤对化疗药物敏感,手术联合术后辅助化疗是标准治疗方案。对于对侧卵巢和子宫未受肿瘤累及,并且有生育需求的患者均应行保留生育功能的手术。但肿瘤本身、手术和放化疗均可能造成患者不孕,术后可能需要借助辅助生殖技术助孕,本文通过1例卵巢卵黄囊瘤患者手术和术后化疗后行自然周期-体外受精-胚胎移植(NC-IVF-ET)的个案报道和文献复习,探讨卵巢卵黄囊瘤患者的生育助孕策略。     

卵巢肿瘤保留生育力现状

卵巢肿瘤的发病率逐步年轻化,3%～14%的患者在育龄期诊断,在ⅠA～ⅠB期小于44岁女性的5年生存率高达91.2%。因此,在不影响生存率的情况下保留患者生育功能愈来愈重要。文章主要对卵巢肿瘤保留生育功能的手术治疗和辅助生殖技术的现状进行阐述。     

妇科恶性肿瘤与辅助生殖技术

妇科恶性肿瘤的发病年龄趋于年轻化，越来越多的女性确诊时仍有生育要求。不同的抗癌治疗方案对患者的生育能力都有一定的影响，应用辅助生殖技术可帮助部分患者完成生育愿望。文章对妇科三大恶性肿瘤的辅助生殖技术方式及安全性进行阐述。     

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.     

CT及MRI在附件包块中的诊断价值

CT和MRI能区分附件良恶性包块、炎性包块，但MRI更有优势。文章讨论了附件包块分类；常见卵巢良、恶性肿瘤及炎性包块的影像学特点和鉴别要点；CT和MRI在卵巢恶性肿瘤分期、附件扭转中的重要诊断价值。期待借助于CT和MRI，为附件包块的诊治提供精准的支持。     

Ovarian cancer in girls]

DESIGN: The aim of our study was a clinical analysys of diagnosis, operative treatment and monitoring of epithelial ovarian cancer in girls. MATERIALS AND METHODS: Authors described 11 epithelial malignant tumors of ovaries in girls aged 12-16. Clinical aspects, pathology stage, grade treatment, monitoring and survival were evaluated. Three of the patients had ovarian cancer. A 19-year old patient with stage Ia of epithelial ovarian cancer was managed conservatively. Four years later she give birth. For 10 years no malignant of has been observed. Seven patients with ovarian borderline epithelial tumors were treated. The tumors in 5 patients were of serous and in 2 of mucinous type. CONCLUSIONS: We suggested that patients of stage I who wish to preserve childbearing function may be treated with unilateral salpingo-ovariectomy and chemotherapy.     

Adjuvant and post-surgical treatment in non-epithelial ovarian cancer

Non-epithelial cancers arising from the ovary are uncommon malignancies. Germ cell tumors of the ovary arise from primordial germ cells, and sex cord-stromal tumors of the ovary represent a cluster of tumors arising from the sex cord and stromal compartment. Most patients diagnosed with germ cell tumors are young adults and adolescent females. In contrast, ovarian sex cord-stromal tumors more commonly occur in a mature age group.Advances in the adjuvant management of non-epithelial ovarian cancer following optimal surgical and pathological staging have improved patient survival outcomes. In addition, active surveillance is preferentially assigned to patients diagnosed with stage I germ cell tumor, stage 1A grade 1 immature teratoma, stage 1A yolk sac tumor, and stage 1AI sex cord-stromal tumors.This article discusses the importance of selecting the adjuvant treatment approach most suitable to the patients' surgical and pathological stages, thereby safeguarding patient outcomes.     

Management of malignant ovarian germ cell tumors

Malignant ovarian germ cell tumors are rare, highly curable cancers of young women. The majority of patients can be cured with either fertility-preserving surgery alone or a combination of surgery and chemotherapy. Relapses occur in 10% to 20% of patients, and the significant proportion of them can be salvaged with chemotherapy. There is no evidence that treatment for malignant ovarian germ cell tumors will adversely affect menstrual or reproductive functions, increase future pregnancy loss, or increase the risk of congenital malformations of the fetus. Late effects, such as secondary leukemia, from chemotherapy are reported but rare. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVE: After completing this CME activity, physicians should be better able to diagnose ovarian germ cell tumors, outline management of malignant ovarian germ cell tumors, and understand the impact of treatment on fertility and late effects.     

Preservation of ovarian function, reproductive ability and emotional attitudes in patients with malignant ovarian tumors

OBJECTIVES: Although cancer is predominantly a disease of aging, an increasing number of women survive malignancies before or during their reproductive years, which may interfere with their fertility potential. Although a variety of studies have tried to document the impact of conservative treatment aimed at preserving ovarian function and reproductive ability, little information has been available regarding survivors' attitudes, emotions, and choices to have children. The aim of this study is to evaluate the reproductive history, experiences, attitudes, and emotions with regard to having children in conservatively treated patients with Stage I epithelial ovarian cancer, any stage LMP tumors, malignant ovarian germ cell tumors (MOGCTs) and Stage I sex cord-stromal tumors (SCSTs). STUDY DESIGN: Between 1986 and 2000, a total of 75 patients with primary malignant ovarian tumors underwent conservative treatment. Out of 75 patients in the study, 14 women (19%) presented Stage I epithelial ovarian cancer, 23 (31%) LMP tumors, 33 (43%) MOGCTs, and five (7%) SCSTs. Information was obtained from medical records and from a questionnaire mailed to all patients who were at least 15 years old at the time of the diagnosis (68 subjects). Median time of follow-up was 102 months (35-192 months). There were four (5.2%) clinical recurrences within 35 months. Only 20 patients (49%) had tried to conceive after the completion of their treatment; of these, 15 women (75%) succeeded and delivered 19 healthy children. Seventy percent (32/41) of the respondents claimed that their disease did not have any impact on their desire to have children. Whereas 51% (21/41) fear that their ovarian disease could have damaged their reproductive potential, 76% (31/41) are not concerned about the effects of the treatment they received on offspring. The impact of the disease on the patients' attitudes toward life was reported as positive. CONCLUSION: The results from our study, in agreement with the data from the literature, confirm that management of Stage I (grade 1, grade 2) epithelial ovarian cancer, any stage LMP tumors, MOGCTs and Stage I SCSTs with fertility-sparing surgery is a safe, practicable treatment option. Though preliminary, this survey provides insight into the attitudes and experiences of young women ovarian cancer survivors regarding fertility.     

Five-year survival rate of postoperative ovarian cancer patients:a 15-year retrospective study

Objective:Ovarian cancer has the highest mortality rate of all gynecologic tumors. We compared the survival rate of ovarian cancer patients with different histological types and different time periods,aiming to elucidate the therapeutic effect and provide more evidence for the prevention and treatment of ovarian cancer.Methods:605 patients with ovarian cancer who underwent surgery at Qilu Hospital,Shandong University from September 1998 to August2012 were retrospectively reviewed. The 5-year survival rate was calculated in epithelial ovarian cancer(EOC)and non-epithelial ovarian cancer(Non-EOC). In addition,the patients were divided into two groups according to time at diagnosis(September 1998 to August 2007 and September 2007 to August 2012). The difference of 5-year survival rate between these two periods was compared.Results:The 5-year overall survival rate of all patients with ovarian cancer was59. 2% from September 1998 to August 2012. The survival rate of patients with EOC was lower(63. 0%)than that of Non-EOC(90. 8%). For both histological types,the 5-year survival rate of patients with localized disease(90. 8%)was significantly higher than that of patients with distant-stage(57. 6%). For different time periods,there was no significant difference in 5-year survival rate between ovarian cancer with different stages.Conclusion:Histological types and stages are closely related to survival of patients with ovarian cancer. More comprehensive clinical and follow-up information could provide convincing evidence for the prevention and treatment of ovarian cancer.     

Clinical review of 55 cases of malignant ovarian germ cell tumors

PURPOSE OF INVESTIGATION: A retrospective analysis of 55 cases of malignant germ cell tumors in a 20-year period was done to evaluate the impact of conservative surgery and adjuvant treatment on survival and fertility. METHODS: Fifty-five cases of malignant ovarian germ cell tumors (MOGCTs) were studied. Mean age was 22 years. Dysgerminoma was the most common histotype (45%). RESULTS: Thirty-nine patients (71%) presented with FIGO surgical Stage I disease. Fertility-sparing surgery was performed in 39 (71%) women. Postoperative systemic chemotherapy was administered to 40 women (73%), 27 (68%) had received conservative treatment. One woman developed renal failure after the first cycle of chemotherapy and died a few days thereafter and there was one case of bleomycin-induced death due to pulmonary fibrosis. There were eight (14.5%) clinical recurrences. Overall survival rate for relapsing women was 75% (6/8). The recurrence rate for women treated conservatively was 15%, and it was 13% for those treated radically. With a median follow-up of 129 months the overall survival rate for the entire study-population was 90.9%. Eleven pregnancies occurred in 36 women treated with fertility-sparing surgery who were of child-bearing age. CONCLUSION: The management of MOGCTs with fertility-sparing surgery is a safe, practicable treatment option. The majority of these patients can retain normal ovarian function and reproductive potential after chemotherapy treatment.