卵巢恶性肿瘤保留生育功能治疗52例临床分析

目的:评价卵巢恶性肿瘤保留生育功能手术和化疗对生育和卵巢功能的影响.方法:回顾性分析我院1996年6月至2010年6月卵巢恶性肿瘤行保留生育功能治疗并有完整随访资料的52例患者的临床资料,对其手术、术后化疗及术后月经和妊娠情况进行分析,并对是否行全面分期手术和不同病理类型行保留生育功能治疗后的生存率和复发率相比较,以及是否化疗的妊娠率进行比较.结果:52例患者中生殖细胞恶性肿瘤25例,上皮性恶性肿瘤12例,交界性肿瘤15例.复发3例,其中1例死亡.计划妊娠41例中妊娠成功16例,2例流产.术后化疗的38例患者中,2例化疗期间月经正常,36例在化疗1～2次后停经,但停止化疗后月经恢复.52例患者中行全面分期手术(15例)的生存率和复发率与行附件切除术或卵巢肿瘤剥除术(37例)比较,差异均无统计学意义(P均＞0.05).3种病理类型肿瘤患者保留生育功能治疗后的生存率和死亡率比较,差异均无统计学意义(P＞0.05).化疗患者中的妊娠率与未化疗患者的妊娠率比较,差异也无统计学意义(X2 =0.1186,P＞0.05).结论:卵巢恶性肿瘤保留生育功能治疗是有效和可行的,化疗对卵巢功能可能有影响,但可以逆转.保留生育功能手术以附件切除术或病灶切除术为宜,但结论尚有待大样本量研究及长期随访.

Fertility Preservation in 52 Patients with Ovarian Malignant Tumor

Objective: To evaluate the effects of fertility-preserving surgery and chemotherapy on fertility and ovarian function in patients with ovarian malignant tumor.Methods:The clinical data of 52 patients with ovarian malignant tumor receiving fertility-preserving treatments were retrospectively analyzed, including surgerypostoperative chemotherapy,postoperative menstruation and pregnancy, survival rate and recurrence rate. The correlation was also analyzed between chemotherapy and pregnancy rate.Results: Among the 52 patients, 25 cases were malignant ovarian germ cell tumors,12 were malignant epithelial carcinomas,15 were borderline epithelial ovarian tumors.3 patients relapsed,and one died. Of 41 patients who want pregnancy, 16 patients succeeded. 38 patients had postoperative chemotherapy, among them, 2 patients experienced normal menstruation, 36 patients experienced menopause after 1~2 cycles of chemotherapy,but menstrution recovered thereafter. When 15 patients who received comprehensive staging surgery were compared with 37 patients who carried with ovarian tumor resection or adnexectomy ,the survival rate and the recurrence rate were no statistical significant difference ( P >0.05) . No statistical significant difference was found in survival rate and mortality among different pathological types ( P>0.05) . There were no statistical significant difference in pregnancy rate in the patients with or without chemotherapy ( χ2 = 0.1186,P>0.05) . Conclusions: Fertility-preserving treatments are an effective and feasible way for patients with ovarian malignant tumor. Ovary function impairment may occur in the process of chemotherapy,but chemotherapy-related amenorrhea is reversible. Ovarian tumor resection or adnexectomy may be the best way for fertility-preserving treatments,However,further investigations are warranted.