Critchley Hilary O D, Bath Louise E, Wallace W Hamish B
Section of Obstetrics and Gynaecology, Department of Reproductive and Developmental Sciences, Centre for Reproductive Biology, University of Edinburgh, 37 Chalmers Street, Edinburgh EH3 9ET, UK.
Hum Fertil (Camb). 2002 May;5(2):61-6. doi: 10.1080/1464727022000198942.
At the present time approximately 1 in 1000 young people aged between 16 and 35 years will have been cured of cancer in childhood and some of the treatment regimens used will have predictable effects on their future fertility prospects. In young women who have been exposed to radiotherapy below the diaphragm, the reproductive problems include the risk of ovarian failure and significantly impaired development of the uterus. The magnitude of the risk is related to the radiation field, total dose and fractionation schedule. Premature labour and low birth weight infants have been reported after flank abdominal radiotherapy. Female long-term survivors treated with total body irradiation and marrow transplantation are also at risk of ovarian follicular depletion and impaired uterine growth and blood flow, and of early pregnancy loss and premature labour if pregnancy is achieved. Despite standard oestrogen replacement, the uterus of these young girls is often reduced to 40% of normal adult size. Uterine volume correlates with the age at which radiation was received. Regrettably, it is likely that radiation damage to the uterine musculature and vasculature adversely affects prospects for pregnancy in these women. It has been demonstrated that, in women treated with total body irradiation, sex steroid replacement in physiological doses significantly increases uterine volume and endometrial thickness, as well as re-establishing uterine blood flow. However, it is not known whether standard regimens of oestrogen replacement therapy are sufficient to facilitate uterine growth in adolescent women treated with total body irradiation in childhood. Even if the uterus is able to respond to exogenous sex steroid stimulation, and appropriate assisted reproductive technologies are available, a successful pregnancy outcome is by no means ensured. The uterine factor remains a concern and women who are survivors of childhood cancer and their carers must recognize that these pregnancies will be at high risk.
目前，每1000名16至35岁的年轻人中约有1人在儿童期患癌后已治愈，且所采用的一些治疗方案会对其未来生育前景产生可预测的影响。在接受过膈下放疗的年轻女性中，生殖问题包括卵巢功能衰竭的风险以及子宫发育明显受损。风险程度与辐射野、总剂量和分次照射方案有关。据报道，侧腹放疗后会出现早产和低体重儿。接受全身照射和骨髓移植治疗的女性长期幸存者也有卵巢卵泡耗竭、子宫生长和血流受损的风险，若怀孕则有早期流产和早产的风险。尽管进行了标准的雌激素替代治疗，这些年轻女孩的子宫往往缩小至正常成年女性大小的40%。子宫体积与接受放疗的年龄相关。遗憾的是，子宫肌肉组织和血管的辐射损伤可能会对这些女性的怀孕前景产生不利影响。已证明，在接受全身照射的女性中，生理剂量的性类固醇替代可显著增加子宫体积和子宫内膜厚度，并重新建立子宫血流。然而，尚不清楚标准的雌激素替代治疗方案是否足以促进童年期接受全身照射的青春期女性的子宫生长。即使子宫能够对外源性性类固醇刺激作出反应，且有合适的辅助生殖技术可用，也绝不能确保获得成功的妊娠结局。子宫因素仍然令人担忧，童年期癌症幸存者及其护理人员必须认识到这些妊娠将面临高风险。
