卵巢恶性肿瘤患者保留生育功能手术的指征及处理原则

年轻的卵巢恶性肿瘤患者施行保留生育功能手术应限于早期且组织学类型较好者，如高、中分化上皮性肿瘤而非透明细胞瘤。术后一般不影响预后，且妊娠结局良好。而对中、晚期患者一般不推荐施行保留生育功能手术。卵巢交界性肿瘤患者年龄相对较轻，而且在诊断时多为Ⅰ期肿瘤，施行保留生育功能手术后妊娠成功率甚高。对卵巢交界性肿瘤患者甚至可行卵巢囊肿剥除术，其并不影响预后。生殖细胞肿瘤患者行保留生育功能手术的文献报道多为无性细胞瘤，手术成功率较高。而对晚期或其他类型生殖细胞肿瘤患者也有尝试保留生育功能手术，但这仅为个案报道，通常并不推荐施行保留生育功能手术，除非患者及家属有强烈意愿。对于施行保留生育功能手术的卵巢恶性肿瘤患者，由于具体情况不同，手术应因人而异行个体化治疗。

The Indication and Principle of Management for Patients with Ovarian Malignancies Undergoing Fertility-sparing ;Surgery

Young patients with ovarian malignancies undergoing fertility-sparing surgery(FSS) should be limited to early stage(Ⅰa) with favorable histology, such as high or moderate differentiation, non-clear-cell histology. But for those with advanced stage or unfavorable histology, generally FSS is not recommended. In patients with borderline ovarian tumor, their age is relatively young and most with early stage, after FSS even with ovariocystectomy, the prognosis is not affected. Their fertility outcome is good. In patient with germ cell tumor deal with FSS, most literature reports are dysgerminoma. But for other types of germ cell tumors, or advanced stages, usually FSS is not recommended unless the patient and her family have a strong will. The patients undergoing FSS due to the specific situation is different, the operation should vary from person to person, and individualized.