卵巢恶性肿瘤保留生育功能58例临床资料分析
发布时间：2018-09-03 09:41
【摘要】：背景 近年来，卵巢恶性肿瘤的发病呈年轻化趋势，发病时相当一部分患者尚未生育，加之现代女性对生活质量的要求越来越高，越来越多的患者要求保留其生育及卵巢内分泌功能。由于手术方式及辅助化疗方案的不断发展，患者的预后越来越好，这也是为我们保留患者的生育功能提供了良好的基础。文献报道保留生育功能治疗后，交界性卵巢肿瘤患者I期患者5年生存率高达99%，晚期患者5年存活率也高达65~96%；而卵巢上皮性癌（Ia或Ic期）及恶性生殖细胞肿瘤保留生育功能肿瘤后的5年存活率也高达90%以上。 目的 评估卵巢恶性肿瘤患者保留生育功能手术、辅助化疗及治疗后的妊娠情况及卵巢功能变化。 资料与方法 回顾性分析2000.01-2012.12年郑州大学第一附属医院收治的年龄40岁以下，行保留生育功能治疗的卵巢恶性肿瘤患者的临床资料（共58例），所有患者均具有完整的随访资料。分析其手术方式、辅助化疗情况、月经及生育情况，同时分析化疗对月经情况、性激素水平及生育情况的影响。 结果 58例保守治疗的患者包括：交界性卵巢肿瘤23例、上皮性卵巢癌5例、生殖细胞肿瘤24例、性索间质细胞瘤6例。手术方式：行患侧肿瘤剥除术者7例，行单侧附件切除术者48例，行一侧附件切除术+对侧肿瘤剥除术者3例。其中，，行全面分期手术者22例。术后化疗：PAC方案2例，BEP方案11例，BVP方案6例，PC方案5例，铂+紫杉醇类化疗7例。5例复发，其中2例死亡。29例患者共妊娠35次，所有子代均健康无畸形。31例术后化疗患者，12例在化疗开始1-4月停经，停止化疗后月经恢复。化疗组与未化疗组月经情况相比，差异具有统计学意义（P0．05）。化疗组停经患者停经期间黄体生成素及卵泡雌激素水平增高，雌二醇水平降低。未化疗组术前术后血清性激素水平无明显变化。未化疗组妊娠率高于化疗组。 结论 1.早期卵巢恶性肿瘤特别是恶性生殖细胞肿瘤，行保留生育功能手术治疗是安全可行的。 2.保留生育功能术后，化疗对卵巢功能有一定的可逆性损害，但对子代无明显致畸作用。由于本研究病例数少，结论可能存在一定的局限性。
[Abstract]:Background in recent years, the incidence of ovarian malignant tumors shows a trend of rejuvenation. At the time of onset, quite a number of patients have not yet given birth. In addition, modern women are demanding more and more high quality of life. More and more patients are demanding to retain their reproductive and ovarian endocrine functions. Because of the continuous development of operation and adjuvant chemotherapy, the prognosis of patients is getting better and better, which provides a good basis for us to retain the fertility function of patients. It is reported that the 5-year survival rate of stage I patients with borderline ovarian tumors is as high as 990.The 5-year survival rate of patients with advanced ovarian tumors is as high as 650.96% after fertility preservation therapy. The 5-year survival rate of ovarian epithelial carcinoma (Ia or Ic stage) and malignant germ cell tumor was 90%. Objective to evaluate the changes of ovarian function and pregnancy in patients with ovarian malignant tumor after preserving reproductive function surgery, adjuvant chemotherapy and treatment. Materials and methods retrospective analysis was made on the patients under 40 years old admitted to the first affiliated Hospital of Zhengzhou University from 2000.01-2012.12. The clinical data of 58 patients with ovarian malignancy treated with fertility preserving therapy were reviewed. All the patients had complete follow-up data. The operation mode, adjuvant chemotherapy, menstruation and fertility were analyzed, and the effects of chemotherapy on menstruation, sex hormone level and fertility were also analyzed. Results 58 patients with conservative treatment included 23 borderline ovarian tumors, 5 epithelial ovarian carcinomas, 24 germ cell tumors and 6 sex cord stromal cell tumors. The operative methods were as follows: 7 cases were treated with tumor excision, 48 cases with unilateral adnexectomy and 3 cases with contralateral tumor excision. Among them, 22 cases were operated by stages. After operation, 2 cases of BEP regimen were treated with 10% PAC regimen, 6 cases with BVP regimen and 6 cases with PC regimen, and 7 cases with recurrence of platinum paclitaxel chemotherapy. Among them, 2 cases died. 29 cases were pregnant for 35 times. All the offspring were healthy. 31 cases of postoperative chemotherapy patients had 12 cases of menopause from 1 to 4 months after the beginning of chemotherapy, and menstruation recovered after stopping chemotherapy. The difference between chemotherapy group and non-chemotherapy group was statistically significant (P0.05). In chemotherapy group, luteinizing hormone and follicle estrogen levels increased and estradiol level decreased during menopause. There was no significant change in serum sex hormone levels before and after chemotherapy in the non-chemotherapy group. The pregnancy rate in non-chemotherapy group was higher than that in chemotherapy group. Conclusion 1. In the early stage of ovarian malignant tumor, especially malignant germ cell tumor, it is safe and feasible to perform fertility preserving surgery. 2. 2. After reserving reproductive function, chemotherapy had some reversible damage to ovarian function, but had no obvious teratogenic effect on offspring. Due to the small number of cases in this study, the conclusion may have some limitations.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.31
本文编号：2219600
[Abstract]:Background in recent years, the incidence of ovarian malignant tumors shows a trend of rejuvenation. At the time of onset, quite a number of patients have not yet given birth. In addition, modern women are demanding more and more high quality of life. More and more patients are demanding to retain their reproductive and ovarian endocrine functions. Because of the continuous development of operation and adjuvant chemotherapy, the prognosis of patients is getting better and better, which provides a good basis for us to retain the fertility function of patients. It is reported that the 5-year survival rate of stage I patients with borderline ovarian tumors is as high as 990.The 5-year survival rate of patients with advanced ovarian tumors is as high as 650.96% after fertility preservation therapy. The 5-year survival rate of ovarian epithelial carcinoma (Ia or Ic stage) and malignant germ cell tumor was 90%. Objective to evaluate the changes of ovarian function and pregnancy in patients with ovarian malignant tumor after preserving reproductive function surgery, adjuvant chemotherapy and treatment. Materials and methods retrospective analysis was made on the patients under 40 years old admitted to the first affiliated Hospital of Zhengzhou University from 2000.01-2012.12. The clinical data of 58 patients with ovarian malignancy treated with fertility preserving therapy were reviewed. All the patients had complete follow-up data. The operation mode, adjuvant chemotherapy, menstruation and fertility were analyzed, and the effects of chemotherapy on menstruation, sex hormone level and fertility were also analyzed. Results 58 patients with conservative treatment included 23 borderline ovarian tumors, 5 epithelial ovarian carcinomas, 24 germ cell tumors and 6 sex cord stromal cell tumors. The operative methods were as follows: 7 cases were treated with tumor excision, 48 cases with unilateral adnexectomy and 3 cases with contralateral tumor excision. Among them, 22 cases were operated by stages. After operation, 2 cases of BEP regimen were treated with 10% PAC regimen, 6 cases with BVP regimen and 6 cases with PC regimen, and 7 cases with recurrence of platinum paclitaxel chemotherapy. Among them, 2 cases died. 29 cases were pregnant for 35 times. All the offspring were healthy. 31 cases of postoperative chemotherapy patients had 12 cases of menopause from 1 to 4 months after the beginning of chemotherapy, and menstruation recovered after stopping chemotherapy. The difference between chemotherapy group and non-chemotherapy group was statistically significant (P0.05). In chemotherapy group, luteinizing hormone and follicle estrogen levels increased and estradiol level decreased during menopause. There was no significant change in serum sex hormone levels before and after chemotherapy in the non-chemotherapy group. The pregnancy rate in non-chemotherapy group was higher than that in chemotherapy group. Conclusion 1. In the early stage of ovarian malignant tumor, especially malignant germ cell tumor, it is safe and feasible to perform fertility preserving surgery. 2. 2. After reserving reproductive function, chemotherapy had some reversible damage to ovarian function, but had no obvious teratogenic effect on offspring. Due to the small number of cases in this study, the conclusion may have some limitations.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.31
【参考文献】
相关期刊论文 前3条
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本文编号：2219600
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