放疗对年轻早期宫颈癌患者卵巢移位术后卵巢功能变化的研究

发布时间：2017-12-30 21:12

本文关键词：放疗对年轻早期宫颈癌患者卵巢移位术后卵巢功能变化的研究　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:宫颈癌是女性最常见的恶性肿瘤之一,近几年宫颈癌的年轻患者越来越多。对于年轻早期宫颈癌患者,现有的治疗模式主要是采取根治性手术,并且根据患者的术后病理情况辅以同步放化疗的综合治疗。然而现有的传统切除双侧卵巢的宫颈癌根治术及放化疗均可影响女性的内分泌功能。卵巢是女性极其重要的内分泌及生殖器官,对维持女性生理和生殖功能起重要作用,同时对人体的新陈代谢及内分泌也起着重要的调节作用。如果女性的卵巢功能丧失,体内的激素水平会突然降低。卵巢功能丧失患者除发生更年期症状,还会出现阴道萎缩、潮热盗汗、性欲减弱、性交疼痛,以及焦虑不安、激动易怒等神经和精神症状,尚可促使或加重某些疾病的产生和发展,如高血压、冠状心脏病及骨质疏松等疾病,严重影响女性的身心健康。因此,对于绝经前女性,保留卵巢功能有十分重要的意义。卵巢对放射线极其敏感且表现为放射剂量依赖,然而远离放射野区域的卵巢却几乎不受放射治疗的影响。因此如何保留卵巢的正常功能,提高宫颈癌患者的生存质量是肿瘤科医生及患者共同关注的问题。目的:本研究旨在探讨年轻早期宫颈癌患者行卵巢腹腔内移位术及术后放射治疗对移位卵巢功能的影响。方法:回顾性分析大连医科大学附属第二医院2002年12月~2016年1月期间收治的40例手术治疗同时行卵巢腹腔内移位术的绝经前IA~IIA期年轻宫颈癌患者的临床资料。其中术后无辅助放疗者为对照组(n=24),有辅助放疗者为研究组(n=16)。分别于术后、放疗后随访宫颈癌患者有无围绝经期症状,并用化学发光免疫法测定血清中促卵泡生成素(FSH)、雌二醇(E2)、促黄体生成素(LH)水平判定卵巢内分泌功能,同时调查性生活情况。比较两组术后1年左右的FSH、E2、LH水平,并作统计学分析。统计学数据处理采用SPSS13.0软件进行处理。其中计数资料采用X2检验,计量资料采用独立样本t检验。以P0.05为差异有统计学意义。结果:(1)围绝经期症状调查:研究组25%(4/16)患者出现了围绝经期症状,症状主要表现为潮热、盗汗、易激和失眠,并同时伴有阴道干涩,分泌物少,性生活困难等不适。然而剩余的12例患者均无围绝经期症状,妇科检查:阴道粘膜柔软、湿润、弹性较好,阴道分泌物无异常。24例对照组患者均无围绝经期症状,血清FSH、E2、LH值正常。结果显示研究组(12/16)患者保留了卵巢功能,对照组100%患者均保留了卵巢功能。(2)性生活调查:术后1年内40例患者均有性生活,34例满意或基本满意。对照组术后1年均有性生活,其性生活基本满意;研究组术后1年有性生活者16例,10例(10/16)患者性生活满意或基本满意,6例(6/16)患者表示为比较满意或不满意。(3)结果表明研究组治疗手段多采用VMAT,卵巢平均治疗受量为600c GY。(4)术后1年左右测定患者的FSH、E2、LH激素水平,与未放疗患者相比,术后放疗上调了宫颈癌患者血清中FSH和LH表达水平,而降低了E2表达水平。对照组(未接受辅助放疗组)与研究组(接受辅助放疗组)比较,数据有差异,P0.05,统计学有意义。结论:行卵巢移位术的年轻宫颈癌患者仍可保留卵巢的正常功能。虽然放射治疗影响卵巢移位术后卵巢的功能,但相对于传统手术后需要辅助放射治疗的年轻宫颈癌患者行卵巢移位术仍可以部分保留卵巢功能。总的来说,卵巢移位术在一定程度上能够避免放射治疗引起的卵巢损伤,改善患者的围绝经期相关症状,提高了术后需要辅助放射治疗患者的生活质量。
[Abstract]:Background: cervical cancer is one of the most common malignant tumors in women. In recent years, more and more young patients with cervical cancer. For young patients with early cervical cancer, the treatment is the main mode to take radical surgery, and comprehensive treatment of the treatment according to the patient's postoperative pathological conditions. However, the existing traditional synchronous resection bilateral ovarian cervical cancer radical mastectomy and chemotherapy can affect the endocrine function of women. Ovarian endocrine and reproductive organs of female is extremely important, for maintaining physiological and reproductive functions play an important role, at the same time on the human body and endocrine The new supersedes the old. also play an important role. If the loss of ovarian function, hormone level in the body the sudden loss of ovarian function in patients with decreased. In addition to the occurrence of menopausal symptoms will appear vaginal atrophy, hectic fever, diminished sexual desire, sexual intercourse pain and anxiety. Restlessness, irritability and other neurological and psychiatric symptoms, generation and development, can cause or aggravate some diseases such as hypertension, coronary heart disease and osteoporosis and other diseases, serious impact on women's physical and mental health. Therefore, for premenopausal women, have very important significance in preserving ovarian function. The ovarian radiation is extremely sensitive and performance dependence of radiation dose, radiation area away from the ovary is hardly affected by radiotherapy. So how to retain the normal function of the ovary, improve the quality of life of patients with cervical cancer is a common cancer doctors and patients. Objective: This study aimed to investigate the effects of ovarian transposition function of radiotherapy young in patients with early cervical cancer ovarian transposition and intra-abdominal surgery. Methods: a retrospective analysis of the Second Affiliated Hospital of Dalian Medical University, December 2002 ~2016 year in January admitted 40 The clinical data of patients with postmenopausal ovarian and intraperitoneal transposition of the pre IA~IIA period of young patients with cervical cancer. The postoperative adjuvant radiotherapy for the control group (n=24), with adjuvant radiotherapy as the research group (n=16) respectively. After operation, the patients after radiotherapy of cervical cancer were perimenopausal symptoms then, the determination of serum FSH by chemiluminescence immunoassay (FSH), estradiol (E2), luteinizing hormone (LH) levels to determine the ovarian endocrine function, and investigate the status of sexual life. FSH, 1 years were compared between the two groups of E2, LH level, and for statistical analysis. Statistical data were processed by SPSS13.0 software. The count data using X2 test, measurement data using independent sample t test in P0.05. The difference was statistically significant. Results: (1) survey of perimenopausal symptoms: study group 25% (4/16) patients with menopausal symptoms, disease Like mainly for hot flushes, sweating, irritability and insomnia, and accompanied by vaginal dryness, little secretion, sexual difficulties and discomfort. However, the remaining 12 patients were perimenopausal symptoms, gynecological examination, vaginal mucosa is soft, moist, good elasticity, no abnormal vaginal secretion of.24 patients in control group were not perimenopausal symptoms, serum FSH, E2, the normal value of LH. The results showed that the study group (12/16) in patients with retained ovarian function, the control group of 100% patients were retained ovarian function. (2) sex survey: within 1 years after surgery in 40 patients had sexual life, 34 cases satisfied or control group. After 1 years of sexual life, sexual life satisfaction; 16 cases of the study group after 1 years of sexual life, 10 cases (10/16) of life of the patients satisfied or basically satisfied in 6 cases (6/16) were expressed as relatively satisfied or not. (3) the results show that the treatment of the study group VMAT, The average weight of 600C by treatment of ovarian GY. (4) after 1 years were determined by FSH, E2, LH levels, compared with patients without radiotherapy, postoperative radiotherapy raised the level of FSH and LH expression in serum of patients with cervical cancer, and reduce the expression level of E2. The control group (without adjuvant radiotherapy group) and study group (adjuvant radiotherapy group), there were differences in the data, P0.05, statistical significance. Conclusion: the normal function of young patients with cervical cancer underwent ovarian transposition can still be retained. Although the effect of ovarian transposition of ovary ovarian function in postoperative radiotherapy, but the traditional surgery need adjuvant radiotherapy for young patients with cervical cancer ovarian transposition can still retain ovarian function. In general, ovarian transposition can prevent ovarian damage caused by radiation therapy to a certain extent, improve the patients with perimenopausal symptoms, improve the postoperative need The quality of life of patients with adjuvant radiation therapy.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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