Van Eijkeren M. A., Van Der Wijk I., El Sharouni S. Y., Heintz A. P. M.
Departments of Obstetrics and Gynaecology and Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands.
Int J Gynecol Cancer. 1999 Sep;9(5):396-400. doi: 10.1046/j.1525-1438.1999.99051.x.
Ovarian function and ovarian cyst formation after radical hysterectomy and pelvic lymphadenectomy with lateral ovarian transposition (LOT) have been retrospectively examined in 54 patients with early stage cervical cancer (FIGO IB or IIA) with a follow-up of 3-7 years. Patients were divided into two groups: those without adjuvant pelvic radiotherapy (36 patients) and those with adjuvant pelvic radiotherapy (18 patients). Ninety-one percent (33/36) of the patients without adjuvant pelvic radiotherapy and 66% (12/18) of the patients with adjuvant pelvic radiotherapy remained without evidence of recurrent disease. Of the 36 patients who did not receive adjuvant pelvic radiotherapy, only two patients became postmenopausal (5.5%). However, of the 18 patients who also received adjuvant pelvic radiotherapy, 5 became postmenopausal (28%). There was a tendency to become postmenopausal if the scatter radiation dose at the transposed ovaries was 300 cGy or more, but our series is too small to allow a definite conclusion. This scatter radiation dose did not depend on the distance the ovaries were placed from the linea innominata, because of the variation in the level of the cranial border of the radiation field. Three out of 54 patients (5.5%) developed symptomatic ovarian cysts, of which 2 required surgical intervention because of pain symptoms. Remarkably, in one of them cyst formation occurred 5 years after surgery. Of the 3 patients with symptomatic ovarian cysts this was the only patient who received adjuvant pelvic radiotherapy. From these data it can be concluded that LOT protects ovarian function in most patients undergoing radical hysterectomy and pelvic lymphadenectomy for early stage cervical cancer, even if they receive adjuvant pelvic radiotherapy, with an acceptable risk of development of symptomatic ovarian cysts.
对54例早期宫颈癌（国际妇产科联盟IB期或IIA期）患者进行了回顾性研究，这些患者接受了根治性子宫切除术和盆腔淋巴结清扫术并进行了卵巢移位术（LOT），随访时间为3至7年。患者分为两组：未接受辅助盆腔放疗的患者（36例）和接受辅助盆腔放疗的患者（18例）。未接受辅助盆腔放疗的患者中有91%（33/36）和接受辅助盆腔放疗的患者中有66%（12/18）仍无疾病复发迹象。在36例未接受辅助盆腔放疗的患者中，只有2例进入绝经后状态（5.5%）。然而，在18例同时接受辅助盆腔放疗的患者中，有5例进入绝经后状态（28%）。如果移位卵巢处的散射辐射剂量为300 cGy或更高，有进入绝经后状态的趋势，但我们的病例系列太小，无法得出明确结论。由于辐射野颅侧边界水平的变化，这种散射辐射剂量并不取决于卵巢与无名线的距离。54例患者中有3例（5.5%）出现有症状的卵巢囊肿，其中2例因疼痛症状需要手术干预。值得注意的是，其中1例在术后5年出现囊肿形成。在3例有症状的卵巢囊肿患者中，这是唯一接受辅助盆腔放疗的患者。从这些数据可以得出结论，对于大多数因早期宫颈癌接受根治性子宫切除术和盆腔淋巴结清扫术的患者，即使他们接受辅助盆腔放疗，卵巢移位术也能保护卵巢功能，且出现有症状卵巢囊肿的风险可接受。
