保守性手术对交界性卵巢肿瘤预后及生育功能的影响

目的；研究首次行保守手术后交界性卵巢肿瘤（BOT）患者的生育功能和疾病结局。方法：对自1990年1月－2000年5月在我院住院43例符合筛选条件的BOT患者行问卷调查及回顾性病例分析，采用SAS软件包对数据进行处理。结果：43例病人中，41例病人完成问卷调查，26例为浆液性交界性卵巢肿瘤（SBOT）；17例为粘液性交界性卵巢肿瘤（MBOT），平均随访时间是63个月，术后无肿瘤复发29例，肿瘤复发14例（包括1例死于肿瘤复发，1例死于其它疾病），平均复发时间是术后39．3个月。卵巢肿瘤剥除术后肿瘤复发率58．3％（7／12），而卵巢切除术后肿瘤复发率22．6％（7／31），两者差异有显著性（Fisher精确概率P＝0．0351），但保守手术后肿瘤复发死亡率并不高于根治性手术（P＝0．64），术后24例有生育愿望的妇女，12例获得妊娠，妊娠年龄范围23－34岁，平均25岁，结论：保守手术可作为BOT患者的一种治疗选择；尽管术后肿瘤复发率较高（33％，14／43），尤其是行卵巢肿瘤剥除术的病人，但肿瘤复发死亡率并未增加；术后有妊娠愿望者能够再次妊娠并分娩正常后代。

Outcome and reproductive function after conservative surgery for borderline ovarian tumors

Purpose:To study reproductive function and disease outcome in women with borderline ovarian tumors (BOT) who were treated with primary conservative surgery. Methods:From January 1990 to May 2000, the clinical data eligible according to criterions in our hospital , which had been statistically managed by SAS software package, were retrospectively reviewed and questionnaires were accepted in all cases with BOT. Results:41 of the 43 patients with a median follow up time of 63 months, finished our questionnaires. Of the 43 selected patients, 26(60.5%) were classified as serous borderline ovarian tumors (SBOT), 17(39.5%) mucous borderline ovarian tumors(MBOT) . 29 patients were free after primary conservative surgery and 14 cases with recurrence including one patient who died of tumor recurrence and the other died of intercurrent disease .The median recurrence time after conservative surgery was 39.3 months and the recurrence was more frequent in patients treated with ovarian cystectomy than in those treated with oophorectomy alone (58% compared with 22%, Fisher exact probability =0.0351). The death rate due to conservative surgery was not higher than that seen in hysterectomy and bilateral adnexectomy (Fisher exact probability=0.64)?Moreover, twelve of the 24 patients attempting pregnancy(50%) had conceived of which the median age was 25 years, with a range of 23-34 years. Conclusions: Conservative surgery remains a therapeutic option in selected patients with BOT. Although the rate of recurrence is relatively high especially in those treated with ovarian cystectomy, mortality from cancer remains about the same in patients with conservative surgery or radical operations. Many patients who desire pregnancy are able to conceive and deliver healthy offspring.