Villella Jeannine A, Parmar Madhu, Donohue Kathleen, Fahey Cathy, Piver M Steven, Rodabaugh Kerry
Department of Gynecologic Oncology, Buffalo, NY 14263, USA.
Gynecol Oncol. 2006 Sep;102(3):475-9. doi: 10.1016/j.ygyno.2006.01.006. Epub 2006 Feb 13.
Current surgical recommendations for ovarian cancer prophylaxis in women at high risk of developing ovarian cancer include bilateral salpingo-oophorectomy (risk-reducing salpingo-oophorectomy (RRSO)). The role of hysterectomy is unclear. We sought to determine outcomes following prophylactic surgery in high-risk women.
We surveyed unaffected members of the Gilda Radner Familial Ovarian Cancer Registry who had undergone oophorectomy from 1981 to 2002. Data were collected and analyzed for statistical significance by the Fisher's Exact Test.
Two hundred eighty women were surveyed, and 154 (55%) responded; 97% were Caucasian and 14% reported being Jewish. The median age of the respondents was 51 years (range 29-79); median age at oophorectomy was 41 years (range 15-68). Fifty-eight patients (38%) reported a laparoscopic procedure. One hundred five patients (68%) had a simultaneous hysterectomy, and 4 (3%) had a prior hysterectomy. Forty-four patients (29%) underwent BSO only. Of these 44 patients, 40 (91%) did not require a subsequent hysterectomy. Of the 4 who did, 2 were for leiomyomas, one for menorrhagia and the other was unknown. While not statistically significant, of the 3 patients who developed a subsequent gynecologic malignancy, all had undergone a hysterectomy. There was a statistically significant difference in whether or not the uterus was removed as part of the procedure by time period, whereby women treated prior to 1990 had a higher likelihood of having a hysterectomy (P = 0.03).
The women in our study did not require hysterectomy for prevention of malignancy. We conclude that one should screen for benign gynecological indications for hysterectomy when planning a prophylactic BSO for prevention of ovarian cancer. Other potential risk factors for endometrial cancer, including the role of UPSC in HBOC, remain to be elucidated.
目前针对卵巢癌高危女性的卵巢癌预防手术建议包括双侧输卵管卵巢切除术（降低风险的输卵管卵巢切除术（RRSO））。子宫切除术的作用尚不清楚。我们试图确定高危女性预防性手术后的结果。
我们对1981年至2002年期间接受卵巢切除术的吉尔达·拉德纳家族性卵巢癌登记处未受影响的成员进行了调查。通过Fisher精确检验收集数据并分析其统计学意义。
共调查了280名女性，154名（55%）作出回应；97%为白种人，14%报告为犹太人。受访者的中位年龄为51岁（范围29 - 79岁）；卵巢切除时的中位年龄为41岁（范围15 - 68岁）。58名患者（38%）报告采用了腹腔镜手术。105名患者（68%）同时进行了子宫切除术，4名（3%）曾接受过子宫切除术。44名患者（29%）仅接受了双侧输卵管卵巢切除术。在这44名患者中，40名（91%）不需要后续的子宫切除术。在需要进行子宫切除术的4名患者中，2名是因为子宫肌瘤，1名是因为月经过多，另一名原因不明。在3名随后发生妇科恶性肿瘤的患者中，虽然无统计学意义，但均接受了子宫切除术。按时间段划分，手术中是否切除子宫存在统计学显著差异，即1990年前接受治疗的女性进行子宫切除术的可能性更高（P = 0.03）。
我们研究中的女性不需要进行子宫切除术来预防恶性肿瘤。我们得出结论，在计划进行预防性双侧输卵管卵巢切除术以预防卵巢癌时，应筛查子宫切除的良性妇科指征。子宫内膜癌的其他潜在危险因素，包括子宫浆液性乳头状癌在遗传性乳腺癌卵巢癌综合征中的作用，仍有待阐明。
