卵巢交界性肿瘤患者保留生育功能术后行辅助生殖技术助孕4例报告并文献复习  

A REPORT OF 4 CASES OF ASSISTED REPRODUCTION AFTER FERTILITY-SPARING SURGERY IN PATIENTS WITH BORDERLINE OVARIAN TUMORS AND LITERATURE REVIEW

作　　者：葛彦欣[1] 刘辉[1] 相燕洁 GE Yanxin;LIU Hui;XIANG Yanjie(Department of Reproductive Medicine,Rizhao People’s Hospital,Rizhao 276800,China)

机构地区：[1]日照市人民医院生殖医学科,山东日照276800 [2]上海交通大学医学院附属新华医院

出　　处：《精准医学杂志》2023年第5期396-399,共4页Journal of Precision Medicine

摘　　要：目的探讨早期卵巢交界性肿瘤(borderline ovarian tumors,BOTs)患者保留生育功能手术的安全性及促排卵方案的选择。方法收集2015年1月—2021年12月患早期BOTs行保留生殖功能手术、后因不孕症就诊于上海交通大学医学院附属新华医院行辅助生殖助孕分娩的4例患者的临床资料,结合文献复习患者术后随访及助孕情况,并比较拮抗剂方案、长方案、来曲唑微刺激方案患者在HCG日雌二醇水平。结果4例早期BOTs患者中有2例行保留生育功能手术后复发,复发的病理类型均为BOTs,未见恶性转化,复发后行二次手术,随访期间未见再次复发。4例均行辅助生殖助孕分娩,其中1例复发者于再次手术前取卵,术后冻胚移植获妊娠。4例中3例使用来曲唑微刺激方案(其中2例妊娠,另1例未获卵后改用长方案妊娠),其余1例采用拮抗剂方案妊娠。与拮抗剂方案及长方案比较,来曲唑微刺激方案的患者在HCG日血清雌激素水平最低。结论早期BOTs患者行保留生育功能手术是安全可行的。肿瘤复发后可酌情于再次手术前行辅助生殖技术取卵。来曲唑微刺激方案对卵巢的不良刺激小,是相对安全的药物选择。Objective To explore the safety of fertility-sparing surgery and the selection of ovulation induction protocols in patients with early-stage borderline ovarian tumors(BOTs).Methods Clinical data were collected from four patients with early-stage BOTs who underwent fertility-sparing surgery and later sought treatment for infertility with assisted reproduction and successfully delivered in Xinhua Hospital Affiliated to School of Medicine in Shanghai Jiao Tong University from January 2015 to December 2021.The postoperative follow-up and assisted reproduction of the patients were reviewed in combination with the literature.The estrogen levels of patients on HCG day were compared between antagonist protocol,agonist protocol,and letrozole mild stimulation protocol.Results Two of the four patients with early-stage BOTs relapsed after fertility-sparing surgery.The pathological type of relapse was BOTs without malignant transformation.No recurrence was observed during follow-up after the second operation.All four patients underwent assisted reproduction and achieved delivery.One of the patients who experienced relapse underwent oocyte retrieval before the second surgery and achieved pregnancy through frozen embryo transplantation after the surgery.Three out of four patients used letrozole mild stimulation protocol(two of them achieved pregnancy,while the other patient switched to agonist protocol after failing to retrieve oocytes and subsequently became pregnant).The remaining patient used anta-gonist protocol and achieved pregnancy.Compared with the antagonist and agonist protocols,letrozole mild stimulation protocol had the lowest serum estrogen level on the HCG day.Conclusion Fertility-sparing surgery for patients with early-stage BOTs is safe and feasible.Oocyte retrieval can be considered in case of recurrence before reoperation.Letrozole mild stimulation protocol provides a relatively safe option with minimal adverse effects on the ovaries.

关 键 词：卵巢肿瘤 保留生育能力 生殖技术 辅助 来曲唑 诱导排卵 

分 类 号：R737.31[医药卫生—肿瘤] R713.6[医药卫生—临床医学]