摘要
目的:探讨保留卵巢对宫颈鳞癌患者术后卵巢功能、骨质丢失以及性生活的影响。方法:选择2000-01/2005-03解放军总医院妇产科进行选择根治性手术治疗且<45周岁的宫颈鳞癌Ⅰ～Ⅱa期患者为观察对象。并按照患者保留卵巢的意愿分为实验组(n=74例,保留单侧或双侧卵巢)和对照组(n=89例,切除双侧卵巢)。所有患者分别于术后3,6个月门诊复查。①利用化学发光免疫测定法检测卵巢功能水平,血清促卵泡刺激素研成>40IU/L、促黄体生成素>35IU/L、雌二醇<50pmol/L者判定为卵巢功能衰竭。②应用DPX-L型双能X射线骨密度仪测定腰椎前后位(L1～L4)4个位点及右髋部3个位点(股骨颈、大转子和Ward氏三角区)的骨密度,计算骨丢失率=(1-术后6月骨密度值/术后3月骨密度值)×100%。③根据改良的Kuppermann评分法进行性激素缺乏症状评分,即症状程度乘以症状指数。症状程度分为4级:无0分;偶有1分;持续2分;影响生活3分。症状指数为固定值:潮热出汗是4,感觉异常、失眠、易激动、性交痛、泌尿系症状是2,抑郁、眩晕、疲乏、骨关节/肌肉痛、头痛、心悸、皮肤蚁走感是1。总分为0～63分。④应用Montgomery-Asberg抑郁量表评价患者的精神心理情况,采用7级(0～6分)的记分法,取总分和单项评分两项统计指标,总分60～0分,得分越低代表患者抑郁症状越少,心理越正常。严重程度总均分以总分/10表示。⑤详细询问性生活恢复情况。以专科工作者作为评定员,检查方法为开放式,采用临床会谈方式,询问患者症状情况后根据患者回答标明患者量表得分情况,一次评定约需要15min。组间比较采用t,χ2检验。结果:所有患者均于术后3,6个月回院复查,全部进入结果分析。①两组患者术后3,6个月后卵巢功能水平情况:实验组患者术后6个月发生卵巢功能衰竭占16%(12/74),均为术后追加放疗的患者,其中4例是原位保留卵巢患者,8例是移位保留卵巢患者。而对照组患者术后3个月不论放疗与否100.0%(89/89)发生卵巢功能衰竭。差异极显著(χ2=4.96,P<0.01)。实验组患者术后3,6个月雌激素水平明显高于对照组;促卵泡素及促黄体生成素水平显著低于对照组。②骨质丢失情况:对照组术后3,6个月骨质丢失率分别为4.1%、5.3%。实验组骨质丢失率分别为0.5%、0.7%,差异有极显著意义(χ2=5.34～4.21,P<0.01)。其中未发生卵巢功能衰竭的患者术后无明显骨质丢失现象,因追加放疗出现卵巢功能丧失的12例患者骨质丢失率分别为3.7%、4.2%。③性激素缺乏症状评分:实验组术后性激素缺乏症状平均评分低于对照组(术后3个月17.4,44.1分;术后6个月20.6,51.3分),差异有极显著意义(χ2=6.31～5.76,P<0.01)。④性生活恢复情况:实验组患者术后3,6个月恢复性生活的例数,平均频次均高于对照组,差异有极显著意义(χ2=7.58～5.96,P<0.01)。⑤两组患者术后3,6个月精神心理状态评定结果:实验组术后3,6个月抑郁量表总分明显低于对照组;实验组术后3,6个月严重程度分项均分明显低于对照组。结论:保留卵巢能够较好避免雌激素水平低落,防止骨质丢失和性激素缺乏,并可使患者恢复性生活,提高生活质量。
AIM： To investigate influence of reserving ovary on the function of ovarian function, bone loss and sexual life in postoperative patients with cervical cancer. METHODS： Patients younger than 45 years old with cervical cancer of Ⅰ to Ⅱ a stages, who selected radical surgery treatment in the Clinical Research Center of Oncology, Guangzhou Meidical College between January 2000 and March 2003, were divided into study group （n=74, unilateral or bilateral ovaries were reserved） and control group （n=89, bilateral ovaries were resected） according to their will for reservation of ovary. All the patients were reexamined 3 and 6 months postoperation. ①The level of ovarian function was detected with chemiluminescent irmnunoassay, those with serum follicle stimulating hormone 〉 40 IU/L, luteinizing hormone 〉 35 IU/L, and estradiol 〈 50 pmol/L were diagnosed to have ovarian failure. ②The bone mineral density at 4 sites of anterior and posterior lumbar spine （L1 to L4） 3 site of right hip （neck of femur, greater trochanter and Ward＇s triangle） was detected with the DPX-L type dual energy X-ray absorptiometry, and the rate of bone loss was calculated with the formula of （1-bone mineral density 6 months postoperation/bone mineral density 3 months postoperation）×100%. ③The symptom of sex hormone deficiency was scored with the modified Kuppermann method, that was, the severity of symptom multiple the index of symptom. The severity of symptom was divided into 4 grades： 0 as none, 1 as occasionally, 2 as continuously, 3 as affecting life; the index of symptom was a fixed value： 4 for hectic fever and sweating, 2 for paresthesia, insomnia, agitation, intercourse pain and urinary symptoms, 1 for depression, dizziness, tiredness, pain at bone joint/muscle, headache, palpitation and crawing feeling at skin; The total score was 0 to 63 points. ④The mental and psychological status of the patients was evaluated with Montgomery-Asberg depression scale, the 7-grade （0 to 6 points） scoring method was used, the total score and single item score were used as the statistical indexes, the total score was 60 to 0 point, the lower the score, the fewer the depressive symptoms and the more normal their psychological status. The average total score of severity was expressed with total score/ 10. ⑤The recovery of sexual life was inquired in details： It was openly inquired by the special staff as the judges by means of clinical talking, and then the scores were given according to the patients＇answers, it cost 15 minutes for each evaluation. The t test and chi-square test were used for intergroup comparison. RESULTS： All the patients were reexamined in the hospital 3 and 6 months postoperation, and involved in the analysis of results. ①Levels of ovarian function of patients in both groups 3 and 6 months postoperation： Six months postoperation, ovarian failure occurred in 16% （12/74） of the paffents in the study group, all of them received radiotherapy, including 4 cases of in situ reservation of ovary and 8 cases of displaced reservation of ovary; All the patients, received radiotherapy or not, in the control group had ovarian failure （100.0%, 89/89）; the difference was extremely different （X^2=4.96,P 〈 0.01）. At 3 and 6 months postoperation, the levels of estradiol in the study group were obviously higher than those in the control group, and the levels of follicle stimulating hormone and luteinizing hormone were significantly lower than those in the control group. ② Bone loss： The rates of bone loss at 3 and 6 months postoperation were extremely and significantly different between the control group （4.1%, 5.3%） and study group （0.5 %, 0.7%） （X^2=5.34 to 4.21, P 〈 0.01）. The patients without ovarian failure had no obvious bone loss, the rates of bone loss in tha 12 patients with ovarian failure caused by radiotherapy were 3.7% and 4.2%. ③Scores of sex hormone deficiency： The average scores were extremely and significantly lower in the study group than in the control group （3 months postoperation： 17.4 and 44.1 points; 6 months postoperation： 20.6 and 51.3 points） （X^2=6.31 to 5.76, P 〈 0.01）. ④Recovery of sexual life： The number of case with recovery of sexual life and average frequency at 3 and 6 months postoperation were extremely and significantly higher in the study group than in the control group （X^2=-7.58 to 5.96, P 〈 0.01）. ⑤Evaluation of mental and psychological status at 3 and 6 months postoperation： The total scores of depression scale were obviously lower in the study group than in the control group; The item scores of severity were obviously lower in the study group than in the control group. CONCLUSION： The reservation of ovary can help to avoid low sex hormone syndrome postoperation, prevent the bone loss and deficiency of sex hormone, improve the recovery of patients＇ sexual life, and improve their quality of life.
出处
《中国临床康复》
CSCD
北大核心
2005年第24期186-188,共3页
Chinese Journal of Clinical Rehabilitation
