摘要
目的探讨年轻早期宫颈鳞癌患者腹腔镜手术并卵巢侧面移位术(LOT)后影响卵巢内分泌功能的因素,探讨监测卵巢内分泌功能的客观指标。方法选取石河子大学医学院第一附属医院妇科2005年4月～2007年10月腹腔镜宫颈鳞癌手术时行LOT的19例及卵巢原位保留的3例总共22例早期年轻(手术年龄<45岁)宫颈鳞癌患者为研究对象,通过测定患者术前术后血清女性激素及抑制素B水平、B超检查及患者填写围绝经期综合征量表,调查术后卵巢内分泌功能及并发症的情况。结果6例LOT患者术后6个月FSH、LH水平、Kupperman评分与术前比较差异有显著性(P<0.05);LOT后未放疗组13例与LOT后放疗组6例及卵巢原位保留放疗组3例相比,LOT后放疗组FSH、LH、Kupperman评分放疗组高于未放疗组(均P<0.05),低于原位保留放疗组(均P<0.05);LOT手术年龄40～45岁患者7例,卵巢功能正常者2例,卵巢功能减退者5例;<40岁患者12例,卵巢功能正常者9例,卵巢功能减退者3例,两组均无卵巢功能丧失,两组之间卵巢功能正常的比例差异无显著性(P>0.05);双侧卵巢LOT10例,单侧9例,两组之间FSH差异有显著性(P<0.05),LH、E2与Kupperman评分差异均无显著性(P>0.05);22例宫颈癌并LOT患者术后6个月血清抑制素B、FSH、E2值相关性分析,随着卵巢功能的下降,抑制素、E2水平逐渐下降,而FSH逐渐上升。结论年轻宫颈鳞癌患者行宫颈癌手术并LOT时,术后如果不行放疗,卵巢内分泌功能保留良好;放疗对宫颈癌手术时移位的卵巢有一定影响,并不能完全避开放射线照射,但卵巢移位对宫颈癌手术后患者的卵巢内分泌功能起到了很大的保护作用;手术年龄超过40岁的患者仍然可以从LOT得益;在早期宫颈癌手术中若双侧卵巢均正常,应尽量保留双侧卵巢;血清INHB同FSH一样,是反映卵巢储备功能的敏感指标。
[Objective] To investigate the factors of influencing the ovarian function in young women with early stage cervical squamous carcinoma who underwent laparoscopie radical hysterectomy, pelvic lymphadeneetomy and LOT （lateral ovarian transposition）, and the objective indicators of monitoring the ovarian function. [Methods] 22 younger cervical squamous cancer patients （surgery age 〈45 years） including 19 cases who underwent radical hysterectomy, pelvic lymphadenectomy and LOT and 3 cases whose ovaries were retained in situ were recruited to our study. The Kupperman standard （1995） was used to investigate the climacteric syndrome of the patients and combined with FSH, LH, E2 and inhibin B （INHB） to judge ovarian function. And ultrasound was also used to image the transposed ovaries to find out the sequela of LOT. [Results] The female hormone levels and Kupperman score of 6 cases who underwent LOT and postoperation radiotherapy were higher than those in the no radiotherapy group （P 〈0.05）, but were significantly higher than those whose ovaries were retained in situ （P 〈0.05）. In one group, 7 patients accepted the surgery in the age of 40--45 years, 2 patients had normal ovarian function, 5 patients had declined ovarian function. In another group, 12 patients accepted the surgery less than 40 years old, 9 patients had normal ovarian function, 3 patients had deClined ovarian function. Inthe two groups there were not ovarian dysfunction cases. 10 patients underwent bilateral LOT, 9 had unilateral LOT, the FSH level between the two groups was significantly different （P 〈0.05）, LH, E2 and Kupperman score were not significantly different （P 〉0.05）. In the 22 cervical cancer patients who received operation, with the declining of ovarian function, the level of INHB, E2 was declined, and the level of FSH was elevated gradually, the difference was significant between the group of normal ovarian function and that of dechned ovarian function, as well as the group of normal ovarian functio
出处
《中国内镜杂志》
CSCD
北大核心
2009年第3期225-230,233,共7页
China Journal of Endoscopy
基金
新疆生产建设兵团专项基金资助项目项目名称:微创技术在腹部恶性肿瘤诊治中的临床应用研究编号:ZDGG200506
关键词
宫颈鳞癌
卵巢移位
卵巢内分泌功能
抑制素B
cervical squamous cell carcinoma
ovarian transposition
ovarian endocrine function
inhibin B
