| Cervical cancer is one of the most common gynecologic malignant tumors which is second only to breast cancer. In China, incidence rate of cervical cancer still ranks first in gynecologic malignant tumors. In recent years, the incidence rate of cervical cancer shows upward and younger trends; therefore, for treatment to young patients with cervical cancer, only laying emphasis on complete operation, no relapse and extending life time is far from enough. Research shows that non-function of ovary may lead to incretion maladjustment which will result in change of cardiovascular system and fundamental metabolism. Therefore people pay more attention to improving living quality of patients with cervical caner, improving the prognosis and preserving ovarian function. At present treatment for cervical cancer eyes on comprehensive operation based on operation to improve effect. Since ovary is sensitive to radioactive ray, for patients preserve ovaries in operation who may accept radiotherapy treatment after operation need to remove ovaries outside the pelvic irradiation to avoid damage to ovarian function caused by radiotherapy treatment after operation. There is a consensus view that this method is safe for preserving ovarian function; but there are comparative few reports on effect of additional radiotherapy after transposition operation on ovarian function and people can not reach a consensus.This article analyzes from two parts: the first part is to discuss incidence characteristics of women with cervical cancer who are younger than 40 years old and strive to improve early diagnosis and treatment to women who get cervical cancer when they are young. Method: carry out review research to clinical characteristics of 174 patients with invasive cervical cancer between January 2000 and October 2007; while carry out research by taking 62 patients with cervical cancer who were younger than 40 years old as research group and taking 112 patients with cervical cancer who were older than 40 years old as control group.The results suggest that: along with the increase of inpatients with cervical cancer between 2000 and 2007 with years and gradual fall of average age, incidence rate of patients with cervical cancer who were younger than 40 years old showed an upward trend with years. Major clinical performance for research group was contact bleeding and the incidence rate was 56.45%, while the incidence rate for control group was 19.64%; the incidence rate of research group was higher than that of control group obviously; the difference was significant ( P<0.05). Patients of research group≤II a phase are 77.42%; While they were 59.82% of control group, the difference of two group was significant (P<0.05).Compared gross type of cervical cancer in naked eyes , exophytic type of research group covered 61.29%; exophytic type of control group was 44.64%, while the incidence rate of exophytic type of research group was higher than that of control group, the difference was significant (P<0.05). There was no significant difference in dynamical type and histological grade of these two groups. Conclusion: In recent years, the clinical incidence rate of cervical cancer showed upward and younger trends. While clinical performance of young patients with cervical cancer was contact bleeding and mainly was exophytic type in naked eyes. Therefore it was suggested to take cervical cytology examination as a gynecologic routine examination; while colposcopic routine examination could be taken as a kind of routine screening method to find disease in early time and improve correct-diagnosis rate of cervical cancer.Furthermore, discuss over effect of carrying out radiotherapy treatment after radical hysterectomy and ovarian transposition on ovarian function. Method: between 2005 and 2007, 40 patients with cervical cancer who were younger than 45 years old were in accordance with of standard for perserving ovaries; after accepting radical hysterectomy and ovarian transposition simultaneously, take 32 patients who accepted radiotherapy treatment after operation as research group, take eight patients who did not accept radiotherapy treatment as control group 1 and take 12 inpatients who were younger than 45 years old and accepted radical radiotherapy directly in radiotherapy department of our hospital randomly as control group 2.Tracked effects of them after operation ( or after radiotherapy treatment), monitored their serum sexual hormone level, carried out gynecologic examination, and observed climacteric symptoms and living qualities these indicators. The results suggest that: one month after accepting radiotherapy treatment, the E2 level of research group decreased, and one month after accepting operation, the difference of its E2 level compared with that of control group1 was significant (P<0.05). E2 level of control group 2 one month after accepting radiotherapy treatment got sharper decrease than that of research group; compared the E2 level of these two groups, the difference was significant( P<0.05). The E2 level of research group six months after accepting radiotherapy treatment was still lower than that of control group 1 slightly; the difference of these two groups was not significant(P>0.05). E2 level of control group 2 six months after accepting radiotherapy treatment did not increase much and it was lower than that of research group six months after accepting radiotherapy treatment, the difference of these two groups was significant (P <0.05). There were climacteric symptoms in 17 patients of research group one month after accepting radiotherapy treatment and the incidence rate was 53.12%; while there were climacteric symptoms in 10 patients of control group 2 one month after accepting radiotherapy treatment and the incidence rate was 83.33%; compared condition of these two groups, the difference was significant (P<0.05); what was more the degree of climacteric symptoms in control group 2 was more severe than that of research group. Three months after accepting radiotherapy treatment, 12 women of research group were satisfied with their sex lives, the satisfactory rate was 37.50%, the difference was significant compared with women of control group 2 who had recovered sex lives but were not satisfied with their sex lives; degree of vaginal interference and change of vaginal mucosa were slighter than that of control group 2.Six months after accepting radiotherapy treatment, the climacteric symptoms and gynecologic examination of research group improved obviously, satisfatory rate of sex lives increased sharply, but only some patients'symptoms of control group 2 got relieved. Conclusion: ovarian transposition for young patients with cervical cancer can preserve normal ovarian function; especially it was significant for patients who accepted radiotherapy treatment. after operation and external pelvic radiotherapy affect ovarian function after transposition, but along with extension of due time of radiotherapy treatment, most of them got ovarian function recovered, some patients'ovaries could recover to normal level; therefore, ovarian transposition could preserve some ovarian function. When the distance of ovarian transposition is up to 2 cm over anterior superior iliac spine, it can avoid comparatively large damage to ovary caused by radiation, simultaneously it can preserve ovarian internal environment and function situation; in addition if proper protection measures are adopted, it will be favorable to recovery of ovarian function. Apply ovarian indications and standard transposition operation strictly to preserving ovarian function, improving living quality of young patients with cervical cancer and extending their perimenopausal period. But how to choose proper transposition and radiotherapy treatment methods, choose external pelvic treatment or vaginal external radiation and how to reduce effect of radiotherapy dose and shielding measures for preservation of ovaries is as much as possible for further discussion... |
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