Department of Obstetrics and Gynecology, Shiga University of Medical Sciences, Otsu, Japan.
Department of Obstetrics and Gynecology, National Hospital Organization Higashi-Ohmi General Medical Center, Higashiomi, Japan.
Womens Health (Lond). 2024 Jan-Dec;20:17455057241239308. doi: 10.1177/17455057241239308.
Chemotherapy and radiation therapy can cause gonadal dysfunction in women of reproductive age. Ovarian tissue cryopreservation is performed to restore fertility by allowing transplantation of the patient's frozen-thawed ovarian tissue or through future in vitro maturation and in vitro fertilization of frozen-thawed oocytes. Herein, we describe our initial experience with vaginal natural orifice transluminal endoscopic surgery for ovarian tissue preservation in a young woman with malignant tumor. A 23-year-old woman with anaplastic lymphoma kinase-positive malignant lymphoma was scheduled for hematopoietic stem cell transplantation after experiencing relapse following R-cyclophosphamide, doxorubicin, vincristine, and prednisolone therapy. Ovarian tissue cryopreservation was selected as only MII2 oocytes were collected. Vaginal natural orifice transluminal endoscopic surgery was performed to excise the left ovary. Ovarian tissues were frozen using the vitrification method. The operative time was 37 min, and blood loss was minimal. Pathological examination revealed no metastatic findings of malignant lymphoma and no thermal damage to the ovarian tissue due to bipolar disorder. The patient was discharged on the first day postoperatively, and her postoperative course was uneventful. The vaginal natural orifice transluminal endoscopic surgery technique can provide a safe and effective alternative to laparoscopy or laparotomy for the cryopreservation of ovarian tissue in young patients with cancer. We believe this method has potential application in sexually mature female cancer survivors.
化疗和放疗会导致育龄期女性性腺功能障碍。通过移植患者冷冻解冻的卵巢组织，或通过未来冷冻解冻卵母细胞的体外成熟和体外受精，进行卵巢组织冷冻保存以恢复生育能力。在此，我们介绍了我们在一名患有恶性肿瘤的年轻女性中进行经阴道自然腔道内镜手术（NOTES）进行卵巢组织保存的初步经验。一名 23 岁女性患有间变性淋巴瘤激酶阳性恶性淋巴瘤，在接受 R-环磷酰胺、多柔比星、长春新碱和泼尼松治疗后复发，拟行造血干细胞移植。由于仅采集到 MII2 卵母细胞，因此选择了卵巢组织冷冻保存。进行经阴道NOTES 以切除左侧卵巢。采用玻璃化方法冷冻卵巢组织。手术时间为 37 分钟，出血量少。病理检查显示恶性淋巴瘤无转移发现，且由于双极电凝术对卵巢组织无热损伤。患者术后第一天出院，术后恢复顺利。经阴道NOTES 技术可为年轻癌症患者的卵巢组织冷冻保存提供一种安全有效的替代腹腔镜或剖腹术的方法。我们认为这种方法在有性成熟的女性癌症幸存者中有应用潜力。
