卵巢恶性生殖细胞肿瘤术后化疗对卵巢功能的影响研究

目的：观察并探讨卵巢恶性生殖细胞肿瘤（malignant ovarian germ cell tumors，MOGCT）患者术后化疗对卵巢功能的影响。方法：入选本院肿瘤科2009年7月至2012年6月间收治的MOGCT行术后辅助化疗患者34例为研究对象（化疗组），选取同期收治的年龄相近、有生育要求且经手术切除后未经化疗的31例卵巢上皮交界性肿瘤患者作为对照组，化疗组术后进行4个周期顺铂（DDP）＋依托泊苷（VP-16）＋博来霉素（BLM）（PEB）方案或顺铂（DDP）＋紫杉醇（TAX）（PT）方案化疗，术后随访12个月，对比两组血清性激素水平与月经变化情况。结果：①术后6个月，化疗组血清黄体生成素（LH）、促卵泡生成素（FSH）水平明显高于对照组（P＜0.05），而雌二醇（E2）水平则明显低于对照组（P＜0.05）；术后12个月化疗组LH、FSH水平较之6个月时显著下降，E2水平显著上升，两组LH、FSH、E2差异无统计学意义（P＞0.05）。②化疗组化疗期间停经17例（50％）、月经量减少10例（29.4％），截至随访结束，15例（88.2％）停经患者月经复潮，月经量较术前减少；对照组31例患者仅有4例（12.9％）出现月经减少，两组术后月经异常率差异具有统计学意义（χ2＝28.752，P＝0.000）。③化疗组与对照组近期有生育计划且成功妊娠的比例分别为44.0％（11/25）、62.5％（15/24），两组差异无统计学意义（χ2＝1.683，P＝0.195）。结论：MOGCT术后化疗近期可引发性激素水平变化与月经异常，主要表现为血清促性腺激素水平升高、雌激素水平降低、停经，月经异常具有可逆性，复潮后月经量减少。

Effect of postoperative chemotherapy on ovarian function in patients with malignant ovarian germ cell tumor

Objectives：To explore effect of postoperative chemotherapy on ovarian function in patients with malignant ovarian germ cell tumor （MOGCT）.Methods：34 patients having received postoperative chemotherapy after MOGCT between Jul.2009 and Jun.2012 in our hospital were selected as study objects （chemotherapy group）,and 3 1 patients having not received postoperative chemotherapy but with fertility requirements in the same period were selected as control group.Patients in chemotherapy group were applied with 4 courses of cisplatin （DDP）＋etoposide （VP-16）＋bleomycin （BLM）（PEB）or DDP ＋taxol （TAX）（PT）treatment,with12 months of postoperative follow-up.Variations of serum sex hormone levels and menstruation of the two groups were compared.Results：①6 months after the surgery,serum luteinizing hormone （LH）＆amp;follicle stimulating hormone （FSH）levels of chemotherapy group were significantly higher than control group （P〈0.05）,while estradiol （E2） levels were significantly lower than control group （P〈0.05）;12 months after the surgery,the LH and FSH level of chemotherapy group decreased significantly while E2 level increased significantly;difference of all the above indica-tors between the two groups were of no statistically significance （P〉0.05）.②in chemotherapy group,17 （50%） and 10 （29.4%）patients experienced amenorrhea and menstrual volume decrease,and 15 （88.2%）patients re-stored menstruation with reduced volume by the end of follow-up;in the control group,only 4 （12.9%）patients experienced menstrual volume decrease;postoperative menstrual abnormalities rate between the two groups were sta-tistically significant （χ2 =28.752,P=0.000 ）.③ Successful pregnancy rates of chemotherapy and control group was 44% （11/25）and 62.5% （15/24）respectively,without significant difference （χ2 =1.683,P=0.195）. Conclusion：MOGCT postoperative chemotherapy can cause abnormal changes in sex hormone and menstruation, such as increasing serum gonadotropin,reducing estrogen and menelipsis,where menelipsis is reversible with de-creased menstrual volume.