Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Eur J Obstet Gynecol Reprod Biol. 2024 May;296:107-113. doi: 10.1016/j.ejogrb.2024.02.027. Epub 2024 Feb 15.
To investigate the oncological safety and fertility outcomes of different fertility-sparing surgery procedures for bilateral borderline ovarian tumors (BOTs) and to identify the safest and most effective approach to help patients conceive with minimal risk.
A retrospective study of 144 patients (≤40 years) with pathologically confirmed bilateral BOTs were included in the study.The effects of surgery type on fertility outcome and recurrence were compared. Cox regression analysis was employed to determine potential prognostic factors. Survival analysis utilized the Kaplan-Meier method.
Three therapeutic modalities were applied in our study, including bilateral ovarian cystectomy (BOC; n = 29), unilateral adnexectomy + contralateral cystectomy (UAC; n = 4) and radical surgery (n = 61). Totally 33 cases (22.9 %) relapsed during the follow-up period. In 37 % of cases administered conservative surgery, relapses were diagnosed in the first 2 years. Only conservative surgery and adjuvant chemotherapy were risk factors for recurrence. Meanwhile, a pregnancy rate of 55.4 % was obtained in patients with bilateral BOTs. The pregnancy rate was slightly higher but no significant (P = 0.539) difference in patients treated with BOC (n = 17, 63 %) compared with UAC (n = 29, 55.8 %) group. GnRHa treatment significantly improved the clinical pregnancy rate in this study(P = 0.029).
Satisfactory pregnancy rate can be achieved after conservative surgery in patients with bilateral BOTs. BOC is worth recommending for bilateral borderline ovarian tumors and a critical factor in fertility is the preservation of maximum healthy ovarian tissue. Patients should make a pregnancy plan in 2 years after the first surgery. GnRHa increase the rate of successful clinical pregnancies.
探讨不同保留生育功能手术治疗双侧交界性卵巢肿瘤（BOT）的肿瘤安全性和生育结局，以寻找最安全、最有效的方法帮助患者在最小风险下妊娠。
对 144 例经病理证实的双侧 BOT 患者的回顾性研究。比较手术方式对生育结局和复发的影响。采用 Cox 回归分析确定潜在的预后因素。生存分析采用 Kaplan-Meier 法。
本研究应用了三种治疗方法，包括双侧卵巢囊肿切除术（BOC；n=29）、单侧附件切除术+对侧囊肿切除术（UAC；n=4）和根治性手术（n=61）。随访期间共有 33 例（22.9%）复发。在接受保守手术的病例中，有 37%的病例在头 2 年内复发。只有保守手术和辅助化疗是复发的危险因素。同时，双侧 BOT 患者的妊娠率为 55.4%。BOC 组（n=17，63%）与 UAC 组（n=29，55.8%）相比，妊娠率略高，但无统计学差异（P=0.539）。GnRHa 治疗显著提高了本研究的临床妊娠率（P=0.029）。
在双侧 BOT 患者中，行保守手术后可获得满意的妊娠率。BOC 适用于双侧交界性卵巢肿瘤，生育的关键因素是保留最大量的健康卵巢组织。患者应在首次手术后 2 年内制定妊娠计划。GnRHa 增加了临床妊娠成功的几率。
