年轻早期宫颈癌患者卵巢移位术后卵巢功能变化

目的:探讨早期宫颈癌患者实施卵巢移位术后卵巢功能的变化及术后补充放疗对移位卵巢的影响。方法:对大连医科大学附属第一医院2002年1月～2006年1月期间收治的29例年龄≤40岁ⅠA～ⅡA期宫颈癌患者实施宫颈癌根治术的同时行卵巢移位术。将这29例患者作为研究组,其中术后无辅助放疗者12例为研究组1,有辅助放疗者17例为研究组2;选取同年龄段、同期入院的32例行子宫全切并保留双侧卵巢于原解剖位置的子宫良性病变患者作为对照组1,7例行传统宫颈癌根治术(不保留卵巢)的宫颈癌患者作为对照组2。术后3个月、半年、1年随访研究组及两个对照组了解有无围绝经期症状,对研究组同时还调查性生活情况。测定术后1年左右研究组、对照组的FSH、E2水平,进行比较,并作统计学分析。结果:研究组中29例患者2例分别于术后9个月、11个月死亡,17例术后补充放疗。①更年期症状调查:出现更年期症状的患者,术后3个月为10例。未补充放疗的患者占2例,其中1例于术后半年症状消失,另1例及其余8例补充放疗的患者术后1年症状仍持续存在。②性生活调查:术后3个月有性生活者5例,均为术后未补充放疗者,性生活基本满意;术后半年有性生活者16例,11例性生活满意或基本满意;术后1年29例患者除2例死亡以外均有性生活,18例满意或基本满意。③术后1年左右测定FSH、E2水平。研究组1(未放疗组)与对照组1(子宫全切组)比较,P>0.05,无统计学意义;研究组1(未放疗组)与研究组2(放疗组)比较,P<0.05,有统计学意义;研究组2(放疗组)与对照组2(切除卵巢组)比较,P<0.05,有统计学意义。结论:宫颈癌患者术中行卵巢移位术可保留卵巢的功能。术后辅助放疗对卵巢功能有影响,但对于术后需要辅助放疗的宫颈癌患者行卵巢移位术仍能部分保留卵巢功能。

Change of ovarian function in young patients with early cervical cancer after ovarian transposition

Objective:To explore the change of ovarian function in young patients with early cervical cancer after ovarian transposition and the effect of postoperative radiotherapy on transposed ovary. Methods:29 patients less than or equal to 40 with stage ⅠA～ⅡA cervical cancer who were in the hospital from January 2002 to January 2006 were selected,then they underwent ovarian transposition at the same time of radical hysterectomy.29 patients were selected as study group,including 12 patients without postoperative radiotherapy in first study group and 17 patients with assisted postoperative radiotherapy in second study group;32 patients at the same age group with benign uterine lesions who were in the hospital at the same time received total hysterectomy but their bilateral ovaries were retained in the original anatomical location,then they were selected as first control group;7 patients at the same age group with cervical cancer who were in the hospital at the same time received routine radical hysterectomy(bilateral ovaries didn't be retained),then they were selected as second control group.The patients in study group and control group were followed up at 3,6 and 12 months after operation to observe perimenopausal symptoms,the sexual activity of the patients in study group was investigated.The levels of follicle stimulating hormone(FSH) and estradiol in study group and control group were detected in about a year after operation,then the results were compared and analyzed statistically. Results:Among 29 patients in study group,2 patients died on the ninth month and the eleventh month after operation,respectively,the other 17 patients underwent postoperative radiotherapy.Investigation on the menopausal symptoms: menopausal symptoms appeared in 10 patients at 3 months after operation.2 patients didn't receive postoperative radiotherapy,menopausal symptoms disappeared in one patient at half a year after operation,but menopausal symptoms remained in the other patient and 8 patients receiving postoperative radiotherapy.Investigation on the sexual activity: 5 patients had sexual activity at 3 months after operation,all of them didn't receive postoperative radiotherapy,they were satisfied with sexual activity;16 patients had sexual activity at 6 months after operation,11 patients were satisfied or satisfied basically with sexual activity;except 2 dead patients,all the patients in study group had sexual activity,18 patients were satisfied or satisfied basically with sexual activity.In about a year after operation,there was no significant difference in the levels of FSH and estradiol between first study group and first control group(P>0.05);there was significant difference in the levels of FSH and estradiol between first study group and second study group(P<0.05);there was significant difference in the levels of FSH and estradiol between second study group and second control group(P<0.05). Conclusion:For the patients with cervical cancer,intraoperative ovarian transposition can reserve ovarian function.Assisted postoperative radiotherapy has impact on ovarian function,but for the patients with cervical cancer needing assisted postoperative radiotherapy,ovarian transposition can reserve ovarian function partially.