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目的:探讨早期宫颈鳞癌患者行宫颈癌根治术[原位保留双侧卵巢或行侧面卵巢移位术(LOT)]后对卵巢内分泌功能的影响。方法:选取年龄<45岁、病灶<2 cm、FIGO分期为IA2～IB1、未发现区域淋巴结转移的27例宫颈鳞癌患者,其中手术时行LOT的23例,卵巢原位保留的4例,测定患者术前、术后的血清女性激素水平。结果:LOT后未放疗组16例患者术后6个月FSH、LH、E2水平及Kupperman评分与术前比较差异无统计学意义(P>0.05):LOT后放疗组7例患者术后6个月FSH、LH水平、Kupperman评分与术前比较差异有统计学意义(P<0.05);LOT后放疗组FSH、LH、Kupperman评分高于未放疗组(P<0.05),低于原位保留放疗组4例(P<0.05);LOT的手术年龄在40～45岁的9例患者中,卵巢功能正常3例,卵巢功能减退6例;<40岁的患者14例中,卵巢功能正常10例,卵巢功能减退4例。两组均无卵巢功能丧失,两组间卵巢功能正常的比例无显著差异(P>0.05)。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的照射,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获益。
Objective: To investigate the effect of radical hysterectomy on cervical cancer in early stage of cervical squamous cell carcinoma (ovarian or ovarian transposition in situ) and its effect on endocrine function of ovary. Methods: Twenty-seven patients with cervical squamous cell carcinoma who were aged <45 years, lesions <2 cm, FIGO staging was IA2 ~ IB1, and no regional lymph node metastasis were found were selected. Among them, 23 cases underwent LOT during operation, 4 cases retained ovary in situ, Preoperative and postoperative serum levels of female hormone were measured. Results: There was no significant difference in the levels of FSH, LH, E2 and Kupperman scores between the sixteen months after LOT and the non-radiotherapy group (P> 0.05) The FSH, LH and Kupperman scores of FSH, LH and Kupperman scores in the LOT post-radiotherapy group were significantly higher than those in the non-radiotherapy group (P <0.05) (P <0.05). Among the 9 patients with LOT who operated for 40-45 years old, there were 3 cases of normal ovarian function and 6 cases of ovarian dysfunction. Of the 14 patients <40 years old, 10 cases had normal ovarian function , 4 cases of ovarian dysfunction. No ovarian function loss in both groups, no significant difference in the proportion of normal ovarian function between the two groups (P> 0.05). Conclusion: The cervical spondylosis in young patients with cervical cancer surgery and LOT, if not radiotherapy after surgery, ovarian endocrine function retained well; radiotherapy for cervical cancer surgery shift of the ovary have a certain impact, and can not completely avoid radiation exposure, However, ovarian transposition of ovarian endocrine function in patients with cervical cancer surgery has played a great protective effect. Patients surgically over 40 years old can still benefit from LOT.