卵巢非侵袭性低级别浆液性癌保留生育功能手术五例及文献复习

李雷; 冯凤芝; 范融; 娄文佳; 李源; 仝佳丽; 常晓燕; 潘凌亚

doi:10.3969/j.issn.1674-9081.2016.04.009

卵巢非侵袭性低级别浆液性癌保留生育功能手术五例及文献复习

Fertility-sparing Surgery for Ovarian Non-invasive Low-grade Serous Carcinoma and Literature Review

摘要

摘要:
目的分析卵巢非侵袭性低级别浆液性癌(low-grade serous carcinoma, LGSC)患者保留生育功能手术的特点。
方法回顾性收集2015年1月至2015年6月北京协和医院病理诊断为卵巢非侵袭性LGSC且进行保留生育功能手术的患者, 对其临床病理特点、手术过程和随访情况进行总结。
结果共有5例非侵袭性LGSC且保留生育功能患者, 中位年龄29岁(24~34岁); 1例行开腹手术, 4例行腹腔镜手术; 4例手术行卵巢囊肿剔除, 1例患者因为卵巢急性扭转坏死行受累附件切除。1例国际妇产科联盟(International Federation of Gynecology and Obstetrics, FIGO)分期为IB期, 4例为IA期。所有患者术后均未接受进一步治疗。中位随访7个月(6~12个月), 所有患者均未复发, 1例患者自然受孕且母胎情况良好。
结论对于非侵袭性LGSC患者, 能否保留生育功能、保留生育功能手术术后的生育情况、复发率及随诊方案, 仍是目前临床处理的棘手问题。本研究为年轻的非侵袭性LGSC患者提供了保留卵巢的选择, 但患者的长期预后(包括生育和生存)尚有待进一步随访。

Abstract:
Objective To investigate the characteristics of fertility-sparing surgery for non-invasive low-grade serous carcinoma (LGSC) of the ovary.
Methods All the histologically diagnosed patients of non-invasive LGSC who admitted to Peking Union Medical College Hospital and received fertility-sparing surgeries between January 2015 and June 2015 were reviewed and their clinicopathological characteristics, surgical procedures, and follow-up results were retrospectively analyzed.
Results Totally five cases of non-invasive LGSC receiving fertility-sparing surgeries were reviewed. Their median age was 29 years (range, 24-34 years). One case received laparotomy and four received laparoscopies; four cases received ovarian cystectomy and one received emergency unilateral adnexectomy for the affected and necrotic ovary because of acute torsion. One case was diagnosed at International Federation of Gynecology and Obstetrics (FIGO) stage IB, and the other four were at stage IA. All the five cases received no further therapy after the surgery. The median follow-up period was 7 months (range, 6-12 months). No case relapsed so far. One case conceived naturally and both the mother and the fetus were in good condition.
Conclusions For non-invasive LGSC patients, there are many unresolved issues in aspects of spare of fertility, conception after fertility-sparing surgeries, recurrence, and follow-up. Although the possibility to spare the ovary is supported by this study for young non-invasive LGSC patients, long-term prognosis (including fertility and survival) needs to be observed in further follow-up.

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