卵巢腹腔内移位术及术后放疗对年轻早期宫颈癌患者内分泌功能及性生活的影响分析
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摘要
目的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早期宫颈癌患者内分泌功能及性生活情况影响。方法选取行根治性手术保留双侧卵巢于原位置治疗的年轻早期宫颈癌患者20例作为对照组;选取同期实施宫颈癌根治术并采取卵巢移位术40例患者为研究组,其中无放射辅助治疗的20例为研究组1;行放射辅助治疗的20例年轻早期宫颈癌患者为研究组2。用化学发光免疫法测定患者血清中促卵泡生成素(FSH)、雌二醇(E2)、促黄体生成素(LH)水平。结果术后1年左右对比研究组1与对照组激素FSH、E2、EH水平,差异无统计学意义(P>0. 05);研究组1与研究组2术后1年激素水平,差异有统计学意义(P <0. 05);研究组2与对照组比较,差异有统计学意义(P <0. 05)。内分泌及围绝经期调查:研究组40例患者妇科检查时为阴道粘膜柔软、弹性、湿润较好,分泌物正常。但研究组1中患者有2例出现患者存在围绝经期症状,研究组2中有8例存在围绝经期症状,对照组中3例存在围绝经期症状,围绝经期症状主要表现为易激动和失眠,并伴有阴道干涩,分泌物少症状。性生活调查:术后1年研究组20例有性生活,18例满意或基本满意;性生活情况调查:研究组满意或基本满意共计35例(35/40),研究组1占19例,研究组2占16例,5例(5/40)不满意,研究组1占4例,研究组2占1例。不满意的患者诉性生活时阴道干燥疼痛或性欲降低。结论卵巢移位术可保留宫颈癌患者卵巢的功能,术后辅助放射治疗对卵巢功能有一定的影响,但行卵巢移位术对于术后需要辅助放疗的宫颈癌患者仍能部分保留卵巢功能。
Objective To investigate the effect of ovarian intraperitoneal transposition and postoperative radiotherapy on the endocrine function and sexual life of patients with early stage cervical cancer. Methods From January 2016 to June 2017,20 young patients with early stage cervical cancer who underwent radical surgery in our hospital for preserving the bilateral ovaries from the original location were selected as the control group. During the same period,Forty patients with radical surgery and ovarian transposition were selected as the study group. Twenty patients without adjuvant radiotherapy were assigned to study group 1 and 20 young patients with early stage cervical cancer were treated with radiotherapy. The four groups of patients were followed up for a period of one year,mainly to understand the perimenopausal symptoms and sexual life,and serum levels of follicle-stimulating hormone( FSH),estradiol( E2),luteinizing hormone LH) levels determined by chemiluminescence immunoassay. Results There was no significant difference in the levels of FSH,E2 and EH between the control group 1 and the control group 1 year after operation( P > 0. 05). There was a statistical difference between the study group 1 and the study group 2 after 1 year. The significance of learning( P < 0. 05); The difference between the study group 2 and the control group was statistically significant( P <0. 05). Endocrine and perimenopausal investigation: 40 patients in the study group had vaginal mucosa soft,elastic,moist,and normal secretion during gynecological examination. However,2 patients in study group 1 had perimenopausal symptoms,8 patients in study group 2 had perimenopausal symptoms,and 3 patients in the control group had perimenopausal symptoms. Peri-menopausal symptoms were mainly irritated. And insomnia,accompanied by vaginal dryness,less secretions. Sexual life survey: 20 patients in the study group had sex life after 1 year,and 18 patients were satisfied or basically satisfied. Sexual life survey: the study group was satisfied or basically satisfied with 35 cases( 35/40),and the study group 1 accounted for 19 cases. Study group 2 accounted for 16 cases,5 cases( 5/40) were not satisfied,study group 1 accounted for 4 cases,and study group 2 accounted for 1 case. Unsatisfied patients complained of vaginal dryness or decreased libido during sexual life. Conclusion Ovarian transposition can preserve the ovarian function of patients with cervical cancer. Postoperative adjuvant radiotherapy has some effects on ovarian function. However,ovarian transposition can still partially retain ovarian function in patients with cervical cancer requiring adjuvant radiotherapy after operation.
Objective To investigate the effect of ovarian intraperitoneal transposition and postoperative radiotherapy on the endocrine function and sexual life of patients with early stage cervical cancer. Methods From January 2016 to June 2017,20 young patients with early stage cervical cancer who underwent radical surgery in our hospital for preserving the bilateral ovaries from the original location were selected as the control group. During the same period,Forty patients with radical surgery and ovarian transposition were selected as the study group. Twenty patients without adjuvant radiotherapy were assigned to study group 1 and 20 young patients with early stage cervical cancer were treated with radiotherapy. The four groups of patients were followed up for a period of one year,mainly to understand the perimenopausal symptoms and sexual life,and serum levels of follicle-stimulating hormone( FSH),estradiol( E2),luteinizing hormone LH) levels determined by chemiluminescence immunoassay. Results There was no significant difference in the levels of FSH,E2 and EH between the control group 1 and the control group 1 year after operation( P > 0. 05). There was a statistical difference between the study group 1 and the study group 2 after 1 year. The significance of learning( P < 0. 05); The difference between the study group 2 and the control group was statistically significant( P <0. 05). Endocrine and perimenopausal investigation: 40 patients in the study group had vaginal mucosa soft,elastic,moist,and normal secretion during gynecological examination. However,2 patients in study group 1 had perimenopausal symptoms,8 patients in study group 2 had perimenopausal symptoms,and 3 patients in the control group had perimenopausal symptoms. Peri-menopausal symptoms were mainly irritated. And insomnia,accompanied by vaginal dryness,less secretions. Sexual life survey: 20 patients in the study group had sex life after 1 year,and 18 patients were satisfied or basically satisfied. Sexual life survey: the study group was satisfied or basically satisfied with 35 cases( 35/40),and the study group 1 accounted for 19 cases. Study group 2 accounted for 16 cases,5 cases( 5/40) were not satisfied,study group 1 accounted for 4 cases,and study group 2 accounted for 1 case. Unsatisfied patients complained of vaginal dryness or decreased libido during sexual life. Conclusion Ovarian transposition can preserve the ovarian function of patients with cervical cancer. Postoperative adjuvant radiotherapy has some effects on ovarian function. However,ovarian transposition can still partially retain ovarian function in patients with cervical cancer requiring adjuvant radiotherapy after operation.
引文
[1]王泽政,吴玉梅.卵巢腹腔移位在年轻SCC根治术后同步放化疗患者中的应用进展〔J〕.中国医药导报,2016,13(3):60-63.
[2]赵维敬,梁颖,徐斌,等.基于CT的卵巢静脉追踪结合多平面重组识别移位卵巢.〔J〕.医学影像学杂志,2016,26(9):1679-1682.
[3]曹黎娜,石岩,李凤梧. 2种微创术式治疗卵巢囊肿的临床比.较〔J〕.世界最新医学信息文摘:电子版,2016,16(35):11-12.
[4] Takahashi N,Kasamatsu Y,Kado N,et al. Five Cases of Cervical Cancer Where Laparoscopic Ovarian Transposition Was Performed Before Pelvic Radiotherapy〔J〕. Journal of Minimally Invasive Gynecology,2015,22(6):203-203.
[5] Shou H,Chen Y,Chen Z,et al. Laparoscopic ovarian transposition in young women with cervical squamous cell carcinoma treated by primary pelvic irradiation〔J〕. European Journal of Gynaecological Oncology,2015,36(1):25-28.
[6] Clough K B,Goffinet F,Labib A,et al. Laparoscopic unilateral ovarian transposition prior to irradiation:prospective study of 20 cases〔J〕. Cancer,2015,77(12):2638-2645.
[2]赵维敬,梁颖,徐斌,等.基于CT的卵巢静脉追踪结合多平面重组识别移位卵巢.〔J〕.医学影像学杂志,2016,26(9):1679-1682.
[3]曹黎娜,石岩,李凤梧. 2种微创术式治疗卵巢囊肿的临床比.较〔J〕.世界最新医学信息文摘:电子版,2016,16(35):11-12.
[4] Takahashi N,Kasamatsu Y,Kado N,et al. Five Cases of Cervical Cancer Where Laparoscopic Ovarian Transposition Was Performed Before Pelvic Radiotherapy〔J〕. Journal of Minimally Invasive Gynecology,2015,22(6):203-203.
[5] Shou H,Chen Y,Chen Z,et al. Laparoscopic ovarian transposition in young women with cervical squamous cell carcinoma treated by primary pelvic irradiation〔J〕. European Journal of Gynaecological Oncology,2015,36(1):25-28.
[6] Clough K B,Goffinet F,Labib A,et al. Laparoscopic unilateral ovarian transposition prior to irradiation:prospective study of 20 cases〔J〕. Cancer,2015,77(12):2638-2645.