【摘要】：背景 近年來，卵巢惡性腫瘤的發(fā)病呈年輕化趨勢，發(fā)病時相當(dāng)一部分患者尚未生育，加之現(xiàn)代女性對生活質(zhì)量的要求越來越高，越來越多的患者要求保留其生育及卵巢內(nèi)分泌功能。由于手術(shù)方式及輔助化療方案的不斷發(fā)展，患者的預(yù)后越來越好，這也是為我們保留患者的生育功能提供了良好的基礎(chǔ)。文獻(xiàn)報道保留生育功能治療后，交界性卵巢腫瘤患者I期患者5年生存率高達(dá)99%，晚期患者5年存活率也高達(dá)65~96%；而卵巢上皮性癌（Ia或Ic期）及惡性生殖細(xì)胞腫瘤保留生育功能腫瘤后的5年存活率也高達(dá)90%以上。 目的 評估卵巢惡性腫瘤患者保留生育功能手術(shù)、輔助化療及治療后的妊娠情況及卵巢功能變化。 資料與方法 回顧性分析2000.01-2012.12年鄭州大學(xué)第一附屬醫(yī)院收治的年齡40歲以下，行保留生育功能治療的卵巢惡性腫瘤患者的臨床資料（共58例），所有患者均具有完整的隨訪資料。分析其手術(shù)方式、輔助化療情況、月經(jīng)及生育情況，同時分析化療對月經(jīng)情況、性激素水平及生育情況的影響。 結(jié)果 58例保守治療的患者包括：交界性卵巢腫瘤23例、上皮性卵巢癌5例、生殖細(xì)胞腫瘤24例、性索間質(zhì)細(xì)胞瘤6例。手術(shù)方式：行患側(cè)腫瘤剝除術(shù)者7例，行單側(cè)附件切除術(shù)者48例，行一側(cè)附件切除術(shù)+對側(cè)腫瘤剝除術(shù)者3例。其中，，行全面分期手術(shù)者22例。術(shù)后化療：PAC方案2例，BEP方案11例，BVP方案6例，PC方案5例，鉑+紫杉醇類化療7例。5例復(fù)發(fā)，其中2例死亡。29例患者共妊娠35次，所有子代均健康無畸形。31例術(shù)后化療患者，12例在化療開始1-4月停經(jīng)，停止化療后月經(jīng)恢復(fù)�；熃M與未化療組月經(jīng)情況相比，差異具有統(tǒng)計學(xué)意義（P0．05）�；熃M停經(jīng)患者停經(jīng)期間黃體生成素及卵泡雌激素水平增高，雌二醇水平降低。未化療組術(shù)前術(shù)后血清性激素水平無明顯變化。未化療組妊娠率高于化療組。 結(jié)論 1.早期卵巢惡性腫瘤特別是惡性生殖細(xì)胞腫瘤，行保留生育功能手術(shù)治療是安全可行的。 2.保留生育功能術(shù)后，化療對卵巢功能有一定的可逆性損害，但對子代無明顯致畸作用。由于本研究病例數(shù)少，結(jié)論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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.31

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