保守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）患者的生育功能和预后。方法：对自1990年1月至2000年5月，在我院住院43例符合研究条件的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例患者中，41例患者完成问卷调查。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）。平均复发时间为术后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。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患者，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。

The Outcome and Reproductive Function after Conservative Surgery for Borderline Ovarian Tumors

Objective:To study the prognosis and reproductive function in patients with borderline ovarian tumor(BOT)treated with conservative surgery.Methods:From January1990to May2000,the eligible clinical data being statistically analysed by SAS software package were retrospectively reviewed and questionnaires were accepted in all cases of BOT.Results:Among43patients,41cases had been followed up for63months and had completed our questionnaire.Of 43selected patients,26(60.5%)were classified as serous borderlineovarian tumor(SBOT),17(39.5%)mucous borderline ovaran tumor(MBOT).Twenty-nine patients were free from recurrence after conservative surgery;tumor recurrence occurred in14cases including one patient died of recurrence and another patient died of other disease.The mean recurrence time after conserva-tion surgery was39.3months and the recurrence was more frequent in patients treated with ovar-ian cystectomy than in those treated with oophorectomy alone(58%compared with22%,Fisher Exact Probability=0.0351).The death rate attributed to conservative surgery showed not more than those accepted hysterectomy and bilateral adenexectomy (Fisher Exact Probability =0.64).Moreover,12of24patients attempting pregnancy(50.0%)had conceived.Conclusion:Conserva-tive surgery remains a therapeutic option in selected patients with BOT.Although the rate of re-currence is relatively high especially in those treated with ovarian cystectomy,but mortality fromcancer remains no significant difference in patients between conservative surgery and radical oper-ation,and many patients who desire pregnancy are able to conceive and deliver healthy offspring.