卵巢非上皮性恶性肿瘤生育力保护
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摘要
卵巢非上皮性恶性肿瘤约占卵巢肿瘤的10%,且多发生于年轻女性,手术和放化疗虽然能够使患者获得生存机会,但常带来不同程度的生育功能损害,造成其生理及心理上的痛苦,所以在改善卵巢恶性肿瘤患者生存率的同时,尽可能保护患者的生育力成为治疗中的重要问题。卵巢非上皮性癌尤其是恶性生殖细胞肿瘤保留生育功能治疗的效果良好,文章就卵巢非上皮性恶性肿瘤保护生育力的手术治疗、术后辅助治疗的实施及辅助生殖技术的应用等问题进行阐述。
Non-epithelial ovarian malignant tumors account for about 10% of ovarian tumors,and mostly develops in young women.Although surgery and radiotherapy and chemotherapy can make patients get the chances of survival,but often lead to different degrees of damage to reproductive function,causing physical and psychological suffering.While improving the survival rate of patients with malignant ovarian tumors,it is an important research issue to protect the reproductive function of patients as much as possible in the treatment of malignant ovarian tumors.The fertilitysparing treatment has a good effect on non-epithelial ovarian malignant tumors,especially malignant ovarian germ tumors.In this article,we discuss the surgical treatment of fertility protection,the implementation of postoperative adjuvant treatment and the application of assisted reproductive technology in non-epithelial ovarian malignant tumors.
Non-epithelial ovarian malignant tumors account for about 10% of ovarian tumors,and mostly develops in young women.Although surgery and radiotherapy and chemotherapy can make patients get the chances of survival,but often lead to different degrees of damage to reproductive function,causing physical and psychological suffering.While improving the survival rate of patients with malignant ovarian tumors,it is an important research issue to protect the reproductive function of patients as much as possible in the treatment of malignant ovarian tumors.The fertilitysparing treatment has a good effect on non-epithelial ovarian malignant tumors,especially malignant ovarian germ tumors.In this article,we discuss the surgical treatment of fertility protection,the implementation of postoperative adjuvant treatment and the application of assisted reproductive technology in non-epithelial ovarian malignant tumors.
引文
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[2]Martinez F.Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM2015 expert meeting:indications,results and future perspectives[J].Hum Reprod,2017,32(9):1802-1811.
[3]高颖,李艳辉,黄佳语.妇科肿瘤与生育力保护及保存[J].生殖医学杂志,2018,4(27):293-298.
[4]林仲秋,吴妙芳,李晶,等.《FIGO 2015妇癌报告》解读连载三--卵巢癌、输卵管癌、腹膜癌诊治指南解读[J].中国实用妇科与产科杂志,2015,31(12):1074-1081.
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[7]周琦,吴小华,刘继红,等.卵巢恶性肿瘤诊断与治疗指南(第四版)[J].中国实用妇科与产科杂志,2018,34(7):739-749.
[8]魏蒙,杨永秀.卵巢恶性肿瘤保留生育功能治疗[J].国际肿瘤学杂志,2016,43(6):475-478.
[9]Parkinson CA,Hatcher HM,EarlAHM,et al.Multidisciplinary management of malignant ovarian germ cell tumours[J].Gynecol Oncol,2011,121(3):625-636.
[10]Jubilee B,Michael F,Backes FJ,et al.Gynecologic Cancer Intergroup(GCIG)consensus review for ovarian germ cell tumors[J].Inter J Gynecol Can,2014,24(3):48-54.
[11]李斌.妇科恶性肿瘤患者保留生育功能的治疗要点[J].中华临床医师杂志(电子版),2015,3:352-354.
[12]Thrall MM,Paley P,Pizer E,et al.Patterns of spread and recurrence of sex cord-stromal tumors of the ovary[J].Gynecol Oncol,2011,122(2):242-245.
[13]Park JY,Jin KL,Kim DY,et al.Surgical staging and adjuvant chemotherapy in the management of patients with adult granulosa cell tumors of the ovary[J].Gynecol Oncol,2012,125(1):80-86.
[14]Park JY,Kim DY,Suh DS,et al.Outcomes of pediatric and adolescent girls with malignant ovarian germ cell tumors[J].Gynecol Oncol,2015,137(3):418-422.
[15]Zanagnolo V,Pasinetti B,Sartori E.Clinical review of 63 cases of sex cord stromal tumors[J].Eur J Gynaecol Oncol,2004,25(4):431-438.
[16]李艳,潘凌亚.卵巢恶性肿瘤保留生育功能的治疗[J].中华医学信息导报,2016,31(18):20-20.
[17]韦任姬,李力.卵巢恶性生殖细胞肿瘤保留生育功能手术临床研究进展[J].中华妇产科杂志,2014,49(4):312-314.
[18]Schneider DT,Gabriele C,Dieter H,et al.Ovarian sex cordstromal tumors in children and adolescents[J].J Clin Oncol,2005,50(6):2357-2363.
[19]Falcone T,Bedaiwy MA.Fertility preservation and pregnancy outcome after malignancy[J].Curr Opin Obstet Gynecol,2005,17(1):21-26.
[20]Torino F,Barnabei A,Vecchis LD,et al.Chemotherapy-induced ovarian toxicity in patients affected by endocrine-responsive early breast cancer[J].Crit Rev Oncol Hematol,2014,89(1):27-42.
[21]Seung-Chul Y,Woo Young K,Jong-Hyuck Y,et al.Young girls with malignant ovarian germ cell tumors can undergo normal menarche and menstruation after fertility-preserving surgery and adjuvant chemotherapy[J].Acta Obstet Gynecol Scand,2011,89(1):126-130.
[22]Clowse ME,Behera MA,Anders CK,et al.Ovarian preservation by GnRH agonists during chemotherapy:a meta-analysis[J].JWomens Health(Larchmt),2009,18(3):311-319.
[23]Lambertini M,Boni L,Michelotti A,et al.Ovarian Suppression With Triptorelin During Adjuvant Breast Cancer Chemotherapy and Long-term Ovarian Function,Pregnancies,and Disease-Free Survival:A Randomized Clinical Trial[J].JAMA,2015,314(24):2632-2640.
[24]Munhoz RR,Pereira AAL,Sasse AD,et al.Gonadotropin-Releasing Hormone Agonists for Ovarian Function Preservation in Premenopausal Women Undergoing Chemotherapy for EarlyStage Breast Cancer:A Systematic Review and Meta-analysis[J].JAMA Oncol,2016,2(1):65-73.
[25]Lambertini M,Poggio F,Levaggi A,et al.Protecting Ovaries During Chemotherapy Through Gonad Suppression:A Systematic Review and Meta-analysis[J].Obstet Gynecol,2015,126(4):901.
[26]Chen H,Li J,Cui T,et al.Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy induced premature ovarian failure in premenopausal women[J].Cochrane Database Syst Rev,2011,11(11):CD008018.
[27]Pinelli S,Basile S.Fertility Preservation:Current and Future Perspectives for Oncologic Patients at Risk for Iatrogenic Premature Ovarian Insufficiency[J].Biomed Res Int,2018,2018(1):1-9.
[28]Cardozo ER,Thomson AP,Karmon AE,et al.Ovarian stimulation and in-vitro fertilization outcomes of cancer patients undergoing fertility preservation compared to age matched controls:a 17-year experience[J].J Assist Reprod Genet,2015,32(4):587-596.
[29]Levine JM,Joanne FK,Quinn GP,et al.Infertility in reproductive-age female cancer survivors[J].Cancer,2015,121(10):1532-1539.
[30]Rajabi Z,Aliakbari F,Yazdekhasti H.Female Fertility Preservation,Clinical and Experimental Options[J].J Reprod Infer,2018,19(3):125-132.
[31]Rienzi L,Cobo A,Paffoni A,et al.Consistent and predictable delivery rates after oocyte vitrification:an observational longitudinal cohort multicentric study[J].Hum Reprod,2012,27(6):1606-1612.
[32]Tomao F,Pinto AD,Sassu CM,et al.Fertility preservation in ovarian tumours[J].Ecancermedicalscience,2018,12:885.
[33]Donfack NJ,Alves KA,Araújo VR,et al.Expectations and limitations of ovarian tissue transplantation[J].Zygote,2017,25(4):13.
[34]Demeestere I.Orthotopic and heterotopic ovarian tissue transplantation[J].Hum Reprod Update,2009,15(6):649-665.
[35]Ladanyi C,Mor A,Christianson MS,et al.Recent advances in the field of ovarian tissue cryopreservation and opportunities for research[J].J Assist Reprod Genet,2017,34(6):709-722.
[36]国际妇科内分泌学会中国妇科内分泌学分会及共识专家.卵巢组织冻存与移植中国专家共识[J].中国临床医生杂志,2018,46(4):496-500.
[2]Martinez F.Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM2015 expert meeting:indications,results and future perspectives[J].Hum Reprod,2017,32(9):1802-1811.
[3]高颖,李艳辉,黄佳语.妇科肿瘤与生育力保护及保存[J].生殖医学杂志,2018,4(27):293-298.
[4]林仲秋,吴妙芳,李晶,等.《FIGO 2015妇癌报告》解读连载三--卵巢癌、输卵管癌、腹膜癌诊治指南解读[J].中国实用妇科与产科杂志,2015,31(12):1074-1081.
[5]卢淮武,林仲秋.《2018NCCN卵巢癌包括输卵管癌及原发性腹膜癌临床实践指南》解读[J].中国实用妇科与产科杂志,2018,34(5):526-536.
[6]李霞,陈婷婷,黄文倩,等.2018年欧洲肿瘤内科学会《卵巢非上皮性癌诊断、治疗和随访临床实践指南》解读[J].中国实用妇科与产科杂志,2018,34(7):755-757.
[7]周琦,吴小华,刘继红,等.卵巢恶性肿瘤诊断与治疗指南(第四版)[J].中国实用妇科与产科杂志,2018,34(7):739-749.
[8]魏蒙,杨永秀.卵巢恶性肿瘤保留生育功能治疗[J].国际肿瘤学杂志,2016,43(6):475-478.
[9]Parkinson CA,Hatcher HM,EarlAHM,et al.Multidisciplinary management of malignant ovarian germ cell tumours[J].Gynecol Oncol,2011,121(3):625-636.
[10]Jubilee B,Michael F,Backes FJ,et al.Gynecologic Cancer Intergroup(GCIG)consensus review for ovarian germ cell tumors[J].Inter J Gynecol Can,2014,24(3):48-54.
[11]李斌.妇科恶性肿瘤患者保留生育功能的治疗要点[J].中华临床医师杂志(电子版),2015,3:352-354.
[12]Thrall MM,Paley P,Pizer E,et al.Patterns of spread and recurrence of sex cord-stromal tumors of the ovary[J].Gynecol Oncol,2011,122(2):242-245.
[13]Park JY,Jin KL,Kim DY,et al.Surgical staging and adjuvant chemotherapy in the management of patients with adult granulosa cell tumors of the ovary[J].Gynecol Oncol,2012,125(1):80-86.
[14]Park JY,Kim DY,Suh DS,et al.Outcomes of pediatric and adolescent girls with malignant ovarian germ cell tumors[J].Gynecol Oncol,2015,137(3):418-422.
[15]Zanagnolo V,Pasinetti B,Sartori E.Clinical review of 63 cases of sex cord stromal tumors[J].Eur J Gynaecol Oncol,2004,25(4):431-438.
[16]李艳,潘凌亚.卵巢恶性肿瘤保留生育功能的治疗[J].中华医学信息导报,2016,31(18):20-20.
[17]韦任姬,李力.卵巢恶性生殖细胞肿瘤保留生育功能手术临床研究进展[J].中华妇产科杂志,2014,49(4):312-314.
[18]Schneider DT,Gabriele C,Dieter H,et al.Ovarian sex cordstromal tumors in children and adolescents[J].J Clin Oncol,2005,50(6):2357-2363.
[19]Falcone T,Bedaiwy MA.Fertility preservation and pregnancy outcome after malignancy[J].Curr Opin Obstet Gynecol,2005,17(1):21-26.
[20]Torino F,Barnabei A,Vecchis LD,et al.Chemotherapy-induced ovarian toxicity in patients affected by endocrine-responsive early breast cancer[J].Crit Rev Oncol Hematol,2014,89(1):27-42.
[21]Seung-Chul Y,Woo Young K,Jong-Hyuck Y,et al.Young girls with malignant ovarian germ cell tumors can undergo normal menarche and menstruation after fertility-preserving surgery and adjuvant chemotherapy[J].Acta Obstet Gynecol Scand,2011,89(1):126-130.
[22]Clowse ME,Behera MA,Anders CK,et al.Ovarian preservation by GnRH agonists during chemotherapy:a meta-analysis[J].JWomens Health(Larchmt),2009,18(3):311-319.
[23]Lambertini M,Boni L,Michelotti A,et al.Ovarian Suppression With Triptorelin During Adjuvant Breast Cancer Chemotherapy and Long-term Ovarian Function,Pregnancies,and Disease-Free Survival:A Randomized Clinical Trial[J].JAMA,2015,314(24):2632-2640.
[24]Munhoz RR,Pereira AAL,Sasse AD,et al.Gonadotropin-Releasing Hormone Agonists for Ovarian Function Preservation in Premenopausal Women Undergoing Chemotherapy for EarlyStage Breast Cancer:A Systematic Review and Meta-analysis[J].JAMA Oncol,2016,2(1):65-73.
[25]Lambertini M,Poggio F,Levaggi A,et al.Protecting Ovaries During Chemotherapy Through Gonad Suppression:A Systematic Review and Meta-analysis[J].Obstet Gynecol,2015,126(4):901.
[26]Chen H,Li J,Cui T,et al.Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy induced premature ovarian failure in premenopausal women[J].Cochrane Database Syst Rev,2011,11(11):CD008018.
[27]Pinelli S,Basile S.Fertility Preservation:Current and Future Perspectives for Oncologic Patients at Risk for Iatrogenic Premature Ovarian Insufficiency[J].Biomed Res Int,2018,2018(1):1-9.
[28]Cardozo ER,Thomson AP,Karmon AE,et al.Ovarian stimulation and in-vitro fertilization outcomes of cancer patients undergoing fertility preservation compared to age matched controls:a 17-year experience[J].J Assist Reprod Genet,2015,32(4):587-596.
[29]Levine JM,Joanne FK,Quinn GP,et al.Infertility in reproductive-age female cancer survivors[J].Cancer,2015,121(10):1532-1539.
[30]Rajabi Z,Aliakbari F,Yazdekhasti H.Female Fertility Preservation,Clinical and Experimental Options[J].J Reprod Infer,2018,19(3):125-132.
[31]Rienzi L,Cobo A,Paffoni A,et al.Consistent and predictable delivery rates after oocyte vitrification:an observational longitudinal cohort multicentric study[J].Hum Reprod,2012,27(6):1606-1612.
[32]Tomao F,Pinto AD,Sassu CM,et al.Fertility preservation in ovarian tumours[J].Ecancermedicalscience,2018,12:885.
[33]Donfack NJ,Alves KA,Araújo VR,et al.Expectations and limitations of ovarian tissue transplantation[J].Zygote,2017,25(4):13.
[34]Demeestere I.Orthotopic and heterotopic ovarian tissue transplantation[J].Hum Reprod Update,2009,15(6):649-665.
[35]Ladanyi C,Mor A,Christianson MS,et al.Recent advances in the field of ovarian tissue cryopreservation and opportunities for research[J].J Assist Reprod Genet,2017,34(6):709-722.
[36]国际妇科内分泌学会中国妇科内分泌学分会及共识专家.卵巢组织冻存与移植中国专家共识[J].中国临床医生杂志,2018,46(4):496-500.