放疗对早期子宫颈癌患者移位卵巢功能的影响  

Transposed ovarian function conservation in cervical cancer patients with radiotherapy

作　　者：吴小华[1] 李子庭[1] 黄啸[1] 周瑜琪[1] 程玺[1] 蔡树模[1] 张志毅[1] 

机构地区：[1]复旦大学附属肿瘤医院妇瘤科,上海200032

出　　处：《中华妇产科杂志》2005年第4期220-222,共3页Chinese Journal of Obstetrics and Gynecology

基　　金：上海市科学技术委员会科研计划基金资助项目(034107020)

摘　　要：目的 探讨放疗对早期(Ⅰ～Ⅱa期)宫颈癌患者移位卵巢功能的影响.方法 对早期宫颈癌患者62例行广泛性全子宫切除加盆腔淋巴结切除加双侧卵巢结肠旁沟侧方移位术,术后随访患者有无绝经期症状,并测定血清中卵泡刺激素和雌二醇水平以判定卵巢功能.62例患者中,30例未予任何放疗(G0组);17例患者仅术前接受了A点剂量为15 Gy的腔内后装治疗(G1组);15例术后予以45～50 Gy盆腔外照射(G2组),其中14例术前已接受了放疗(方法同G1组).结果 G0、G1和G2组患者卵巢功能衰竭的发生率分别为20% (6/30)、35% (6/17)和64% (9/14),分别两两比较,差异均有统计学意义(P<0.01);3组术后发生卵巢功能衰竭的患者中,其平均衰竭时间分别为15.7、12.0和9.2个月,分别两两比较,差异均有统计学意义( P<0.05).2例(3%)发生了移位卵巢囊肿,未发现卵巢转移.结论 早期宫颈癌患者术前或术后放疗均能明显引起卵巢功能衰竭,甚至卵巢移位手术本身也会影响卵巢的功能.Objective To evaluate the transposed ovarian function and complications in cervical cancer patients with postoperative pelvic radiotherapy. Methods Sixty-two women with stage Ⅰ-Ⅱa cervical cancer were treated with radical hysterectomy and pelvic lymphadenectomy and transposition of both ovaries to paracolic gutters from 1997 to 2003 at the Cancer Hospital of Fudan University. Menopausal symptoms, levels of follicle-stimulating hormone (FSH) and E_2 were evaluated to assess ovarian function. Results Of 31 patients with stage Ⅱa or poorly differentiated tumor or tumor ≥ 2 cm in diameter, preoperative vaginal radiation was employed to deliver a dose of 15 Gy at point A. Postoperative pelvic radiation was performed in 15 patients. Totally 20% (6/30) of patients undergoing ovaries transposition without any radiation experienced ovarian failure within a mean of 15.7 months. In 35% (6/17) of patients with preoperative vaginal radiation, ovarian failure occurred within a mean of 12.0 months. When patients receiving postoperative pelvic radiation and ovaries transposition were considered together, 64% (9/14) experienced ovarian failure within a mean of 9.2 months (P<0.05). Only 2 (3%) patients had cysts in transposed ovaries not requiring further surgery. There was no metastasis of the ovaries. Conclusions Lateral ovarian transposition is safe to patients with early stage cervical cancer. Both pre-and post-operative radiation significantly damages the ovarian function. Even ovaries transposition procedure also reduces the effectiveness.

关 键 词：癌患者 早期 子宫颈 卵巢功能衰竭 广泛性全子宫切除 盆腔淋巴结切除 腔内后装治疗 两两比较 绝经期症状 雌二醇水平 卵泡刺激素 盆腔外照射 G1和G2 双侧卵巢 术后随访 卵巢囊肿 卵巢转移 术后放疗 卵巢移位 统计学 移位术 

分 类 号：R737.33[医药卫生—肿瘤]