睾丸肿瘤治疗对性与生殖功能影响的研究进展
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摘要
睾丸肿瘤是好发于青壮年男性的恶性肿瘤,以手术切除为主、术后辅以放化疗的综合治疗方式,给患者带来极高的生存率。肿瘤疾病及治疗过程中的主要并发症是睾酮水平下降、ED和不育,严重影响患者的生活质量。而手术方式、放化疗和心理因素均会不同程度影响性腺功能,导致ED及生殖能力下降。本文就睾丸肿瘤治疗过程中引起性功能及生殖能力的变化机制进行综述。
Testicular tumor is a malignance that usually occurs in young men. Its treatment mainly relies on surgical resection with postoperative radio-and/or chemotherapy, which can achieve a high survival rate of the patients. The main complications of the tumor and its treatment include a low testosterone level, ED, and infertility, which seriously influence the patients' quality of life. Surgical treatment, radiotherapy, chemotherapy and psychological factors all affect the gonadal function, leading to sexual dysfunction and infertility. This review focuses on the mechanisms of treatment-induced changes in the sexual and reproductive functions of testicular tumor patients and their clinical interventions.
Testicular tumor is a malignance that usually occurs in young men. Its treatment mainly relies on surgical resection with postoperative radio-and/or chemotherapy, which can achieve a high survival rate of the patients. The main complications of the tumor and its treatment include a low testosterone level, ED, and infertility, which seriously influence the patients' quality of life. Surgical treatment, radiotherapy, chemotherapy and psychological factors all affect the gonadal function, leading to sexual dysfunction and infertility. This review focuses on the mechanisms of treatment-induced changes in the sexual and reproductive functions of testicular tumor patients and their clinical interventions.
引文
[1] 王宇,刘春.睾丸生殖细胞肿瘤治疗的新进展.中国现代医药杂志,2016,18(7):94-98.
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[3] 那彦群.中国泌尿外科疾病诊断治疗指南手册.北京:人民卫生出版社,2014.90-114.
[4] Wiechno PJ,Kowalska M,Kucharz J,et al.Dynamics of hormonal disorders following unilateral orchiectomy for a testicular tumor.Med Oncol,2017,34(5):84.
[5] Keske M,Canda AE,Atmaca AF,et al.Testis-sparing surgery:Experience in 13 patients with oncologic and functional outcomes.Can Urol Assoc J,2019,13(3):E83-E88.
[6] Pfister D,Paffenholz P,Haidl F.Testis sparing surgery in patients with germ cell cancer:Indications and clinical outcome.Oncol Res Treat,2018,41(6):356-358.
[7] 陈明,张力杰,许斌.腹膜后淋巴结清扫在睾丸癌治疗中的应用.临床泌尿外科杂志,2018,33(12):937-941.
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[13] Karmakar PC,Cho YJ,Kim YH,et al.Chemotherapeutic drugs alter functional properties and proteome of mouse testicular germ cells in vitro.Toxicol Sci,2018,164(2):465-476.
[14] Coccia PF,Pappo AS,Altman J,et al.Adolescent and young adult oncology,version 2.2014.J Natl Compr Canc Netw,2014,12(1):21-32.
[15] Hamano I,Hatakeyama S,Ohyama C .Fertility preservation of patients with testicular cancer.Reprod Med Biol,2017,16(3):240-251.
[16] 董干,修子超,王沛涛,等.男性恶性肿瘤患者生殖风险与保护.中华男科学杂志,2017,23(3):271-275.
[17] Tinkler SD,Howard GC,Kerr GR .Sexual morbidity following radiotherapy for germ cell tumours of the testis.Radiother Oncol,1992,25(3):207-212.
[18] Stubblefield MD.Neuromuscular complications of radiation therapy.Muscle Nerve,2017,56(6):1031-1040.
[19] 朱智荣,阎家骏,潘建刚,等.睾丸扭转术后患者心理状况调查及相关因素分析.中国男科学杂志,2016,30(9):21-25.
[20] 蔡艳娜,董悦芝.心理压力与男性精液质量相关性Meta分析.中华生殖与避孕杂志,2017,37(4):320-326.
[21] Whirledge S,Cidlowski JA.Glucocorticoids,stress,and fertility.Minerva Endocrinol,2010,35(2):109-125.
[22] Bandak M,Lauritsen J,Johansen C,et al.Sexual function in a nationwide cohort of 2260 testicular cancer after 17 years followup.J Urol,2018,200(4):794-800.
[23] Bryd? YM,Foss? SD,Klepp O,et al.Sperm counts and endocrinological markers of spermatogenesis in long-term survivors of testicular cancer.Bri J Cancer,2012,107(11):1833-1839.
[24] Ghezzi M,Toni LD,Palego P,et al.Increased risk of testis failure in testicular germ cell tumor survivors undergoing radiotherapy.Oncotarget,2018,9(3):3060-3068.
[25] Andrade MBR,Bertolla RP,Intasqui P,et al.Effect of orchiectomy on sperm functional aspects and semen oxidative stress in men with testicular tumours.Andrologia,2019,51(3):e13205.
[2] Batool A,Karimi N,Wu XN,et al.Testicular germ cell tumor:A comprehensive review.Cell Mo Life Sci,2019,76(9):1713-1727.
[3] 那彦群.中国泌尿外科疾病诊断治疗指南手册.北京:人民卫生出版社,2014.90-114.
[4] Wiechno PJ,Kowalska M,Kucharz J,et al.Dynamics of hormonal disorders following unilateral orchiectomy for a testicular tumor.Med Oncol,2017,34(5):84.
[5] Keske M,Canda AE,Atmaca AF,et al.Testis-sparing surgery:Experience in 13 patients with oncologic and functional outcomes.Can Urol Assoc J,2019,13(3):E83-E88.
[6] Pfister D,Paffenholz P,Haidl F.Testis sparing surgery in patients with germ cell cancer:Indications and clinical outcome.Oncol Res Treat,2018,41(6):356-358.
[7] 陈明,张力杰,许斌.腹膜后淋巴结清扫在睾丸癌治疗中的应用.临床泌尿外科杂志,2018,33(12):937-941.
[8] Masterson TA,Cary C,Rice KR,et al.The evolution and technique of nerve-sparing retroperitoneal lymphadenectomy.Urol Clin North Am,2015,42(3):311-320.
[9] Boer H,Proost J H,Nuver J,et al.Long-term exposure to circulating platinum is associated with late effects of treatment in testicular cancer survivors.Ann Oncol,2015,26(11):2305-2310.
[10] Hjelle LV,Bremnes RM,Gundersen POM,et al.Associations between long-term serum platinum and neurotoxicity and ototoxicity,endocrine gonadal function,and cardiovascular disease in testicular cancer survivors.Urol Oncology,2016,34(11)::487.e13-487.e20.
[11] Brouwers EE,Huitema AD,Beijnen JH,et al.Long-term platinum retention after treatment with cisplatin and oxaliplatin.BMC Clin Pharmacology 2008,8:7.
[12] Gietema JA,Meinardi MT,Messerschmidt J,et al.Circulating plasma platinum more than 10 years after cisplatin treatment for testicular cancer.Lancet,2000,355(9209):1075-1076.
[13] Karmakar PC,Cho YJ,Kim YH,et al.Chemotherapeutic drugs alter functional properties and proteome of mouse testicular germ cells in vitro.Toxicol Sci,2018,164(2):465-476.
[14] Coccia PF,Pappo AS,Altman J,et al.Adolescent and young adult oncology,version 2.2014.J Natl Compr Canc Netw,2014,12(1):21-32.
[15] Hamano I,Hatakeyama S,Ohyama C .Fertility preservation of patients with testicular cancer.Reprod Med Biol,2017,16(3):240-251.
[16] 董干,修子超,王沛涛,等.男性恶性肿瘤患者生殖风险与保护.中华男科学杂志,2017,23(3):271-275.
[17] Tinkler SD,Howard GC,Kerr GR .Sexual morbidity following radiotherapy for germ cell tumours of the testis.Radiother Oncol,1992,25(3):207-212.
[18] Stubblefield MD.Neuromuscular complications of radiation therapy.Muscle Nerve,2017,56(6):1031-1040.
[19] 朱智荣,阎家骏,潘建刚,等.睾丸扭转术后患者心理状况调查及相关因素分析.中国男科学杂志,2016,30(9):21-25.
[20] 蔡艳娜,董悦芝.心理压力与男性精液质量相关性Meta分析.中华生殖与避孕杂志,2017,37(4):320-326.
[21] Whirledge S,Cidlowski JA.Glucocorticoids,stress,and fertility.Minerva Endocrinol,2010,35(2):109-125.
[22] Bandak M,Lauritsen J,Johansen C,et al.Sexual function in a nationwide cohort of 2260 testicular cancer after 17 years followup.J Urol,2018,200(4):794-800.
[23] Bryd? YM,Foss? SD,Klepp O,et al.Sperm counts and endocrinological markers of spermatogenesis in long-term survivors of testicular cancer.Bri J Cancer,2012,107(11):1833-1839.
[24] Ghezzi M,Toni LD,Palego P,et al.Increased risk of testis failure in testicular germ cell tumor survivors undergoing radiotherapy.Oncotarget,2018,9(3):3060-3068.
[25] Andrade MBR,Bertolla RP,Intasqui P,et al.Effect of orchiectomy on sperm functional aspects and semen oxidative stress in men with testicular tumours.Andrologia,2019,51(3):e13205.