Feeney D D, Moore D H, Look K Y, Stehman F B, Sutton G P
Department of Obstetrics and Gynecology, Indiana University Medical Center, Indianapolis 46202-5274.
Gynecol Oncol. 1995 Jan;56(1):3-7. doi: 10.1006/gyno.1995.1002.
To assess the effectiveness of lateral ovarian transposition in preserving normal ovarian function, the medical records of 200 consecutive women with stage I-IIA cervical cancer treated primarily with radical hysterectomy and pelvic lymphadenectomy were reviewed. Lateral ovarian transposition was performed at the time of radical hysterectomy in 132 (66%) patients and 28 (21%) received postoperative pelvic radiation therapy. Menopausal symptoms (vaginal dryness, hot flushes) and follicle-stimulating hormone (FSH) levels were used to define ovarian function. Only 3/104 (2.9%) patients who underwent lateral ovarian transposition without postoperative pelvic radiotherapy experienced menopausal symptoms; however, FSH levels in all three cases suggested continued ovarian function. In 14/28 (50%) patients who received postoperative pelvic radiation therapy ovarian failure occurred. The risk of ovarian failure with pelvic radiation therapy after lateral ovarian transposition was significant (RR = 17.3; 95% CI = 5.35-56.13). The incidence of adnexal disease in transposed ovaries requiring analgesics or further surgery was 3%. These data suggest minimal risk to the patient when the ovaries are conserved. Unfortunately, lateral ovarian transposition preserves ovarian function in only 50% of patients undergoing pelvic radiotherapy following radical hysterectomy.
为评估卵巢侧方移位术在保留正常卵巢功能方面的有效性，我们回顾了200例主要接受根治性子宫切除术和盆腔淋巴结清扫术的I-IIA期宫颈癌连续患者的病历。132例（66%）患者在根治性子宫切除术时进行了卵巢侧方移位，28例（21%）接受了术后盆腔放疗。采用更年期症状（阴道干燥、潮热）和促卵泡生成素（FSH）水平来定义卵巢功能。在未接受术后盆腔放疗的104例接受卵巢侧方移位术的患者中，只有3例（2.9%）出现了更年期症状；然而，这3例患者的FSH水平均提示卵巢功能持续存在。在28例接受术后盆腔放疗的患者中，14例（50%）发生了卵巢功能衰竭。卵巢侧方移位术后接受盆腔放疗导致卵巢功能衰竭的风险显著（RR = 17.3；95% CI = 5.35 - 56.13）。需要止痛或进一步手术的移位卵巢附件疾病发生率为3%。这些数据表明保留卵巢对患者的风险极小。不幸的是，在根治性子宫切除术后接受盆腔放疗的患者中，卵巢侧方移位仅能使50%的患者保留卵巢功能。
