子宫内膜异位症根治术时自体卵巢组织移植的应用

目的　评价保守手术后复发的重症子宫内膜异位症 (内异症 )根治术时实施自体卵巢组织移植的价值。方法　常州市妇幼保健院 1997年 2月至 2 0 0 1年 12月对 2 5例子宫内膜异位症保守手术后出现复发的Ⅳ期内异症患者 ,施行根治术或剩余卵巢切除术 ,术时将自体卵巢组织片移植于大网膜之中。术后测定卵泡刺激素(FSH)、黄体生成激素 (LH)和雌二醇 (E2 )。E2 水平上升后 ,测定基础体温 ,做阴道脱落细胞学检查。结果　 2 5例患者中 ,2 0例术后 4～ 6个月E2 水平上升 ,卵巢组织移植成活率为 80 0 %。卵巢功能维持时间最长者已达 4年以上。仅 1例出现内异症复发 ,复发率为 5 0 %。结论　对卵巢组织破坏严重的复发性重症内异症患者 ,根治术时实施卵巢组织移植是保留卵巢功能 ,减少内异症复发的有效方法。

The significance of autologous ovarian tissue transplantation during radical surgery of recurrent endometriosis

Objective To evaluate the efficacy of autologous ovarian tissue transplantation at the time of radical surgery in patients with recurrent endometriosis after conservative surgical procedures.Methods From February 1997 to February 2001,twenty five cases of recurrent endometrosis in the Maternity and Infant Health Hospital of Changzhou underwent radical surgery or ovariosalpingectomy.Their ovarian tissue fragments were transplanted to greater omentum during the time of radical surgery.Serum FSH,LH and E 2 levels were measured once a month respectively.After E 2 was increased,basal body temperature was measured and vaginal hormone cytology was examined weekly for maturation index (MI).Results There were 12 cases who had increase of E 2 four months postoperatively and 8 cases six months later.The other 5 cases were with serum E 2 kept at low levels.The survival rate of transplanted ovarian tissue was 80 0%.The longest with viable ovarian tissues has been over 4 years.Among 25 patients who underwent ovarian tissue trasplantation,only one case had recurrence of endometriosis.The recurrent rate was 5 0%.Conclusion Transplantation of ovarian tissue fragments during radical surgery for recurrent endometriosis is a good method to decrease recurrence of endometriosis as well as reconstruct ovarian function.