卵巢恶性肿瘤年轻患者保留生育功能手术的效果评价

目的总结评价卵巢恶性肿瘤年轻患者保留生育功能手术和术后辅助化疗的效果及对生育功能及卵巢功能的影响.方法回顾性分析四川大学华西第二医院1989-2004年收治的64例接受保留生育功能手术治疗的卵巢恶性肿瘤年轻患者的临床资料.结果初诊时患者中位年龄为20（7～30）岁.64例患者中,卵巢上皮性癌患者22例,恶性生殖细胞肿瘤38例,性索间质肿瘤4例.首次手术方式如下：单侧附件切除术23例;单侧附件切除＋大网膜切除＋阑尾切除术10例,单侧附件切除＋大网膜切除＋阑尾切除＋盆腔淋巴结切除或取样术10例;单侧附件切除＋肿瘤细胞减灭术4例;单侧附件切除＋对侧卵巢楔形切除活检术11例;6例仅行患侧肿瘤剥除术.64例患者平均随访76（5～192）个月,5例（8%）死亡,59例（92%）存活至今,其中卵巢恶性生殖细胞肿瘤患者存活率为89%（34/38）,上皮性癌患者为95%（21/22）,性索间质肿瘤患者全部健在（4/4）.15例患者行二次手术,其中发现癌灶者6例.生存病例中53例患者有月经,除2例周期缩短外,其余患者月经均正常.20例有生育计划的患者中,13例（65%）患者有15次妊娠,9次足月分娩.结论对卵巢恶性生殖细胞肿瘤患者,无论期别如何,行保留生育功能手术是可行的;对于卵巢上皮性癌患者行保留生育功能手术需慎重,仅限于年轻、有强烈生育要求、肿瘤为Ⅰ期、高分化且术后有条件密切随访的患者;坚持规范化疗对卵巢恶性肿瘤的治疗十分必要;化疗对卵巢及生育功能无明显影响.

Evaluation of the effect of fertility-saving surgery on young patients with malignant ovarian tumors

OBJECTIVE: To evaluate the impact of fertility-saving surgery and adjuvant chemotherapy on survival and fertility of young patients with ovarian malignant tumors. METHODS: A retrospective analysis was done on 38 patients with ovarian malignant germ cell tumors, 22 patients with malignant epithelial tumors and 4 patients with sexual cord mesenchymal tumors receiving conservative treatments. Outcomes such as menstruation and reproduction ability were assessed. RESULTS: Fifty-nine among 64 patients have been alive up to now (92%). The overall survival rate for ovarian epithelial malignancies, malignant germ cell tumors and sexual cord mesenchymal tumors were 95% (21/22), 89% (34/38) and 4/4, respectively. Fifteen patients received second operation and recurrence was found in 6 patients. Among the 59 surviving patients, 53 had normal menstruation. Thirteen patients among 20 patients who wanted to get pregnant had 15 pregnancies and 9 successful deliveries. CONCLUSIONS: The management of fertility-saving surgery on patients with ovarian malignant germ cell tumors, whatever the stagings are, is a safe option. For patients with ovarian epithelial carcinomas, fertility-saving surgery is only indicated for low-stage (stage I), high-grade (G1), and patients who hope to maintain fertility function eagerly. Cisplatinum-based combination chemotherapy is necessary. Standardized chemotherapy has no effect on fertility function.