中国首例乳腺癌患者冻存卵巢组织移植成功报道及文献复习  

The first successful case report of breast cancer patient’s cryopreserved ovarian tissue transplantation in China and literature review

作　　者：阮祥燕[1] 杨瑜 卢丹[2] 杜娟[1] 程姣姣 谷牧青[1] 李扬璐[1] 金凤羽[1] 段微[3] 代荫梅[1] 鞠蕊 许新 Matthias Korell Alfred O.Mueck Ruan Xiangyan;Yang Yu;Lu Dan;Du Juan;Cheng Jiaojiao;Gu Muqing;Li Yanglu;Jin Fengyu;Duan Wei;Dai Yinmei;Ju Rui;Xu Xin;Matthias Korell;Alfred O.Mueck(Department of Gynecological Endocrinology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China;Department of Gynecology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China;Department of Gynecological Oncology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China;Johanna-Etienne Hospital in Neuss,Neuss 41462,Germany;Department of Women s Health,University Women s Hospital and Research Centre for Women s Health,University of Tuebingen,Tuebingen D-72076,Germany)

机构地区：[1]首都医科大学附属北京妇产医院内分泌科,北京100026 [2]首都医科大学附属北京妇产医院妇科,北京100026 [3]首都医科大学附属北京妇产医院妇科肿瘤科,北京100026 [4]德国诺伊斯约翰娜艾蒂安医院,诺伊斯41462,德国 [5]德国图宾根大学妇产医院妇女健康部与妇女健康研究中心,图宾根D-72076,德国

出　　处：《首都医科大学学报》2021年第2期177-182,共6页Journal of Capital Medical University

基　　金：北京市自然科学基金(7202047);首都卫生发展科研专项项目(首发2020-2-2112,2016-2-2113);北京市医院管理局临床医学发展专项经费资助(XMLX201710),首都临床特色应用研究课题(Z161100000516143);北京市医院管理局“登峰”计划专项(DFL20181401);2018年度国家外专局引智重点项目(20181100005);中国国际人才交流促进会医疗健康技术创新与人才培养专项基金(2017041900004,2018042000001)。

摘　　要：目的卵巢组织冻存移植防治乳腺癌患者医源性早发性卵巢功能不全(premature ovarian insufficiency, POI)。方法患者35岁,乳腺浸润性导管癌T1CN2M0,雌激素受体α(estrogen receptorα,ERα)(-),孕激素受体(progestone receptor, PR)(-)。在乳腺癌改良根治术后行部分卵巢组织冻存,冻存后开始乳腺癌规范的个体化放射治疗、化学药物治疗和靶向治疗。治疗结束1年后,患者闭经1年多、绝经症状明显,经乳腺专家会诊评估,患者处于无瘤存活状态,且患者卵巢功能检测:卵泡刺激素(follicle stimulating hormone, FSH)101.83 IU/L,抗苗勒管激素(anti-Müllerian hormone, AMH)<0.06 ng/mL,以上检测结果证明患者的卵巢功能已彻底衰退,需要进行冻存卵巢组织移植,患者自身条件也允许,随后进行了移植。结果移植后2个月,患者绝经症状消失,FSH 7.29 IU/L,经阴道B超检测,移植的卵巢有卵泡发育并可自行排卵。移植后3个月,患者月经来潮,证明患者卵巢功能恢复正常,冻存卵巢组织移植成功。现患者移植近3年,卵巢功能正常。结论这是中国首例乳腺癌患者卵巢组织冻存移植成功的报道,卵巢组织冻存移植为防治医源性POI保护生育力提供了一种重要的新技术,本文就此报道并进行文献复习。Objective To prevent and treat iatrogenic premature ovarian insufficiency in breast cancer patient by ovarian tissue cryopreservation and transplantation. Methods Ovarian tissue cryopreservation was performed after modified radical mastectomy in a 35-year-old breast invasive ductal carcinoma [estrogen receptor α(ERα)(-), progestone receptor(PR)(-),T1 CN2M0] patient. Subsequently, normative and individual radiotherapy, chemotherapy and targeted therapy were performed. During and after tumor therapy, she had got amenorrhea for more than one year and experienced obvious menopause symptoms. She had been tumor-free survival consulted and evaluated by breast cancer experts. The ovarian function test showed that follicle stimulating hormone(FSH) was 101.83 IU/L and anti-Müllerian hormone(AMH) was less than 0.06 ng/mL. The data suggested that the patient’s ovarian function was completely exhausted, and the patient needed and met the physical requirement for cryopreserved ovarian tissue transplantation. Consequently, the transplantation was performed. Results Two months after transplantation, the patient’s menopause symptoms disappeared, FSH decreased to 7.29 IU/L, and transvaginal ultrasound showed follicular development and ovulation in the transplanted ovary. Three months after transplantation, her menstruation recovered, indicating that the patient’s ovarian function was completely recovered and the cryopreserved ovarian tissue transplantation was successful. Up to now, the patient has been transplanted for nearly 3 years and the ovarian function remains normal. Conclusion This was the first successful case report of breast cancer patient cryopreserved ovarian tissue transplantation in China. Ovarian tissue cryopreservation and transplantation is a new important technology for prevention and treatment of iatrogenic premature ovarian insufficiency and fertility protection. This manuscript also reviews the literature on this issue.

关 键 词：卵巢组织冻存 移植 乳腺癌 防治 医源性早发性卵巢功能不全 

分 类 号：R711.75[医药卫生—妇产科学]