早期宫颈癌保留卵巢内分泌功能的临床研究

目的:探讨早期宫颈鳞癌患者行宫颈癌根治术[原位保留双侧卵巢或行侧面卵巢移位术(LOT)]后对卵巢内分泌功能的影响。方法:选取年龄<45岁、病灶<2 cm、FIGO分期为IA2～IB1、未发现区域淋巴结转移的27例宫颈鳞癌患者,其中手术时行LOT的23例,卵巢原位保留的4例,测定患者术前、术后的血清女性激素水平。结果:LOT后未放疗组16例患者术后6个月FSH、LH、E2水平及Kupperman评分与术前比较差异无统计学意义(P>0.05):LOT后放疗组7例患者术后6个月FSH、LH水平、Kupperman评分与术前比较差异有统计学意义(P<0.05);LOT后放疗组FSH、LH、Kupperman评分高于未放疗组(P<0.05),低于原位保留放疗组4例(P<0.05);LOT的手术年龄在40～45岁的9例患者中,卵巢功能正常3例,卵巢功能减退6例;<40岁的患者14例中,卵巢功能正常10例,卵巢功能减退4例。两组均无卵巢功能丧失,两组间卵巢功能正常的比例无显著差异(P>0.05)。结论:年轻宫颈鳞癌患者行宫颈癌手术并LOT时,术后如果不行放疗,卵巢内分泌功能保留良好;放疗对宫颈癌手术时移位的卵巢有一定影响,并不能完全避开放射线的照射,但卵巢移位对宫颈癌手术后患者的卵巢内分泌功能起到了很大的保护作用。手术年龄超过40岁的患者仍然可以从LOT获益。

Clinical research on ovarian function in women with early stage cervical squamous carcinoma

Objective:To investigate the factors of influencing the ovarian function in women with early stage cervical squamous carcinoma who underwent radical hysterectomy,pelvic lymphadenectomy and lateral ovarian transpostion(LOT).Methods:27 patients with age less than 45 years old,lesions < 2 cm,FIGO staging for IA2-IB1 and undetected a regional lymph node metastasis of cervical squamous carcinoma were selected,including 23 younger cervical squamous cancer patients with LOT and 4 cases whose ovarian were retained in situ.Kupperman standard was used to investigate the climacteric syndrome of the patients and combined with FSH,LH to judge ovarian function.Results:There were no differences in the female hormone levels and Kupperman score of 16 cases underwent LOT without radiotherapy before and after operation 6 months(P>0.05).There were significant differences in FSH,LH,E2 and Kupperman score of 7 cases underwent LOT and radiotherapy before and after operation 6 months.The level of FSH,LH,Kupperman score in LOT and postoperation radiotherapy group were higher than those of no radiotherapy group(P<0.05),but were significantly lower than those of 4 patients whose ovarian were retained in situ(P<0.05).In 9 patients who accepted the surgery of 40-45 years old,there were 3 patients who had normal ovarian function,6 patients whose ovarian function were declined.In 14 patients who accepted the surgery less than 40 years,there were 10 patients who had normal ovarian function,4 patients whose ovarian function were declined.Above 14 patients had no ovarian afunction and there was no difference between these two groups(P>0.05).Conclusion:LOT is effective in retaining the ovary function of early stage cervical squamous carcinoma patients.Pelvic radiotherapy after LOT can greatly protect the ovary function,but it also partly damages the transposed ovarian.The patients more than 40 years old can also benefit from LOT.