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[卵巢交界性肿瘤:CNGOF临床实践指南 - 简短文本]

[Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Short Text].

作者信息

Bourdel N, Huchon C, Cendos A W, Azaïs H, Bendifallah S, Bolze P A, Brun J L, Canlorbe G, Chauvet P, Chéreau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, Mathieu D'argent E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E

机构信息

Service de chirurgie gynécologique, CHU de Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.

Service de gynécologie et obstétrique, université Versailles-Saint-Quentin-en-Yvelines, CHI Poissy-St-Germain-en-Laye, 10, rue du Champ-Gaillard, BP 3082, 78303 Poissy cedex, France.

出版信息

Gynecol Obstet Fertil Senol. 2020 Mar;48(3):223-235. doi: 10.1016/j.gofs.2020.01.022. Epub 2020 Jan 28.

Abstract

This work was carried out under the aegis of the CNGOF (Collège national des gynécologues et obstétriciens français) and proposes guidelines based on the evidence available in the literature. The objective was to define the diagnostic and surgical management strategy, the fertility preservation and surveillance strategy in Borderline Ovarian Tumor (BOT). No screening modality can be proposed in the general population. An expert pathological review is recommended in case of doubt concerning the borderline nature, the histological subtype, the invasive nature of the implant, for all micropapillary/cribriform serous BOT or in the presence of peritoneal implants, and for all mucinous or clear cell tumors (grade C). Macroscopic MRI analysis should be performed to differentiate the different subtypes of BOT: serous, seromucinous and mucinous (intestinal type) (grade C). If preoperative biomarkers are normal, follow up of biomarkers is not recommended (grade C). In cases of bilateral early serous BOT with a desire to preserve fertility and/or endocrine function, it is recommended to perform a bilateral cystectomy if possible (grade B). In case of early mucinous BOT, with a desire to preserve fertility and/or endocrine function, it is recommended to perform a unilateral adnexectomy (grade C). Secondary surgical staging is recommended in case of serous BOT with micropapillary appearance and uncomplete inspection of the abdominal cavity during initial surgery (grade C). For early-stage serous or mucinous BOT, it is not recommended to perform a systematic hysterectomy (grade C). Follow up after BOT must be pursued for more than 5 years (grade B). Conservative treatment involving at least the conservation of the uterus and a fragment of the ovary in a patient wishing to conceive may be proposed in advanced stages of BOT (grade C). A new surgical treatment that preserves fertility after a first non-invasive recurrence may be proposed in women of childbearing age (grade C). It is recommended to offer a specialized consultation for Reproductive Medicine when diagnosing BOT in a woman of childbearing age. Hormonal contraceptive use after serous or mucinous BOT is not contraindicated (grade C).

摘要

本研究在法国国家妇产科医师学会(CNGOF)的支持下开展,并根据文献中的现有证据提出指南。目的是确定卵巢交界性肿瘤(BOT)的诊断和手术管理策略、生育力保留和监测策略。一般人群中不建议进行筛查。对于交界性性质、组织学亚型、种植灶的浸润性存在疑问的情况,所有微乳头/筛状浆液性BOT、存在腹膜种植灶的情况以及所有黏液性或透明细胞肿瘤(C级),建议进行专家病理复查。应进行宏观MRI分析以区分BOT的不同亚型:浆液性、浆液黏液性和黏液性(肠型)(C级)。如果术前生物标志物正常,不建议进行生物标志物随访(C级)。对于双侧早期浆液性BOT且希望保留生育力和/或内分泌功能的患者,若可能建议行双侧囊肿切除术(B级)。对于早期黏液性BOT且希望保留生育力和/或内分泌功能的患者,建议行单侧附件切除术(C级)。对于微乳头外观的浆液性BOT且初次手术时腹腔检查不完整的情况,建议进行二次手术分期(C级)。对于早期浆液性或黏液性BOT,不建议进行系统性子宫切除术(C级)。BOT术后随访必须持续5年以上(B级)。对于处于BOT晚期且希望怀孕的患者,可考虑至少保留子宫和部分卵巢的保守治疗(C级)。对于育龄期女性首次非侵袭性复发后,可考虑一种保留生育力的新手术治疗方法(C级)。对于育龄期女性诊断为BOT时,建议提供生殖医学专科咨询。浆液性或黏液性BOT后使用激素避孕无禁忌(C级)。

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