Liu Qian, Ding Xi-lai, Yang Jia-xin, Cao Dong-yan, Shen Keng, Lang Jing-he, Zhang Guo-nan, Xin Xiao-yan, Xie Xing, Zhang Shu-lan, Wu Yu-mei, Zhu Gen-hai, Wang Jia, Chen Yi-le, Kong Bei-hua, Zheng Jian-hua
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Fu Chan Ke Za Zhi. 2013 Mar;48(3):188-92.
To investigate the operative treatment for first-treated patients with malignant ovarian germ cell tumors who need preservation of fertility.
The clinical data of 105 patients who were treated with fertility-sparing surgery in 11 hospitals from 1992 to 2010 were collected to evaluate the outcomes of different primary surgical operative procedures. All 105 cases were performed the surgeries that preserved fertility and divided into three groups according to the surgical approaches, comprehensive staging surgery group: 47 cases (44.8%) received comprehensive staging surgeries that including the ipsilateral oophorectomy + omentectomy + retropertoneal lymph node dissection ± appendectomy + multiple biopsies;oophorectomy group:45 cases (42.9%)received ipsilateral oophorectomy ± biopsy of contralateral ovary ± omentectomy;tumor resection group:13 cases (12.4%) received enucleation of the mass with preservation of the ovary. Differences were compared among the three groups of patients in the surgery-related indicators, complications, fertility and prognosis.
(1) Surgery-related indicators:the average blood loss of the comprehensive staging surgery group, the oophorectomy group and the tumor resection group were 496, 104 and 253 ml, the mean operation time were 176, 114 and 122 minutes, respectively, and there were significant differences among three groups (P = 0.011, P = 0.000). (2) Complication:the surgical complication rates of the three groups were 17% (8/47), 0 and 1/13, with significant differences (P = 0.015). (3) Reproductive function status: the pregnancy rate and birth rate of the three groups were no significant differences (9/19 vs. 7/19 vs. 2/3, P = 0.515; 8/19 vs. 5/19 vs. 2/3, P = 0.636). (4) PROGNOSIS: the recurrence rate of the three groups were significant differences [13% (6/47) vs. 0 vs. 2/13, P = 0.013], but the death rate with no significant differences [6% (3/47) vs. 0 vs. 0, P = 0.129]; The five-year survival rate of three different groups were 89%, 100% and 100% (P > 0.05), while disease free survival rate were 85%, 100% and 83% (P < 0.05), respectively.
Compared with comprehensive staging surgery, oophorectomy group have higher surgical security and satisfactory prognosis, considerable pregnancy rates and birth rate. The tumor resection security may be reliable, but the prognosis is poor.
探讨首次治疗且有生育需求的恶性卵巢生殖细胞肿瘤患者的手术治疗方法。
收集1992年至2010年期间在11家医院接受保留生育功能手术的105例患者的临床资料，以评估不同初次手术操作方式的效果。105例患者均接受了保留生育功能的手术，并根据手术方式分为三组，全面分期手术组：47例（44.8%）接受全面分期手术，包括患侧卵巢切除术 + 大网膜切除术 + 腹膜后淋巴结清扫术±阑尾切除术 + 多处活检；卵巢切除术组：45例（42.9%）接受患侧卵巢切除术±对侧卵巢活检±大网膜切除术；肿瘤切除术组：13例（12.4%）行肿瘤剜除术并保留卵巢。比较三组患者在手术相关指标、并发症、生育情况及预后方面的差异。
（1）手术相关指标：全面分期手术组、卵巢切除术组和肿瘤切除术组的平均失血量分别为496、104和253 ml，平均手术时间分别为176、114和122分钟，三组间差异有统计学意义（P = 0.011，P = 0.000）。（2）并发症：三组手术并发症发生率分别为17%（8/47）、0和1/13，差异有统计学意义（P = 0.015）。（3）生殖功能状态：三组的妊娠率和出生率差异无统计学意义（9/19 vs. 7/19 vs. 2/3，P = 0.515；8/19 vs. 5/19 vs. 2/3，P = 0.636）。（4）预后：三组的复发率差异有统计学意义[13%（6/47）vs. 0 vs. 2/13，P = 0.013]，但死亡率差异无统计学意义[6%（3/47）vs. 0 vs. 0，P = 0.129]；三种不同术式组的五年生存率分别为89%、100%和100%（P > 0.05），而无病生存率分别为85%、100%和83%（P < 0.05）。
与全面分期手术相比，卵巢切除术组手术安全性更高，预后良好，妊娠率和出生率可观。肿瘤切除术安全性可能可靠，但预后较差。
