| Objective: To study the effect of ovarian function by displacing the ovary in abdominal cavity after a radical cure postoperative adjuvant radiation assisting with chemotherapy synchronous among young patients of cervical squamous cancer, to provide standardized treatment evidence for protecting the ovarian function.Methods: Retrospective analysis patients age < 45 years old in our hospital conducting radical hysterectomy+retain bilateral/unilateral ovaries + /- displacement of intra-abdominal surgical adjuvant radiation and chemotherapy + /- from January 2011- December 2015,and study the symptoms of the menopausal transition and postmenopausal symptoms and sex hormone levels, and to evaluate the quality of life. Group(n = 147) : select group under the age of 45, IB1, IIA1 stage cervical squamous carcinoma patients, including line cervical cancer radical surgery of ovarian suspension but 60 cases of the line radiation and chemotherapy has a shift group(group, IB1, IIA1 stage cervical squamous carcinoma of 18 cases, 22 cases, 20 cases respectively), line supplement ovarian abdominal cavity after displacement of radiation and chemotherapy after cervical cancer radical shift + in 87 cases of radiation and chemotherapy group(group, IB1, IIA1 period respectively 23 patients with cervical squamous carcinoma, 30 cases, 34 cases). Control group(n = 114) choice for the same period of the group under the age of 45, confirmed IB1, IIA1 stage cervical squamous cell carcinomas in patients with ovarian reserve in situ no suspension(the intraoperative biopsy pathology confirmed without metastasis tumor or primary tumor).Line of radiation and chemotherapy after cervical cancer radical is not shift + in 114 cases of radiation and chemotherapy group(group, IB1, IIA1 stage cervical squamous carcinoma of 35 cases, 44 cases, 38 cases respectively). Surgery plus radiation and chemotherapy after 3 months follow-up, the first year in the second year once every 6 months follow-up, after 3 years follow-up once a year. All the follow-up of patients with gynecological examination, ultrasound, CT/MRI examination, when necessary to understand the pelvic and displacement of ovarian location, size and presence of lesions, etc.; Parallel vaginal stump TCT examination and squamous cell nucleus antigen(SCCA) understanding of tumor recurrence; At the time of the last follow-up check peripheral blood serum blood follicle-stimulating hormone(FSH), luteinizing hormone(LH) and estradiol(E2), and other hormone levels; Ask for details of self-conscious symptom patients, especially the symptoms of the menopausal transition, fill in the menopausal transition time at the end of the follow-up comprehensive scale(Kupperman rating scale), and the world health organization quality of life measurement scale short form(WHOQOL). Statistical analysis, analysis the cervical squamous cancer effect a radical cure postoperative chemoradiation for ovray.Results:This study collected data of 261 patients of age less than 45 years old woman with cervical squamous carcinoma from January 2011 to December 2015 and evaluate the effect of ovarian transposition of the abdominal cavity afeter the radical surgery assiat with cervical cancer adjuvant radiation and chemotherapy.24 cases were lost to follow-up(shift group 5 cases, shift + 8 cases of radiation and chemotherapy group, not shift + 11 cases of radiation and chemotherapy group) and lost to follow-up rate was 9.20%. 3 cases recurrence(shift + 1 case of radiation and chemotherapy group, not shift + radiation and chemotherapy group 2 cases), 1 case of lung metastasis, 2 cases of vaginal stump recurrence, are poorly differentiated squamous cell carcinomas, relapse within 2 years after surgery, not refuse to postoperative adjuvant therapy. 2 cases died(shift + 1 case of radiation and chemotherapy group, not shift + radiation and chemotherapy group 1 case), 1 case died of uremia, 1 case died of multiple organ failure. Shift observed in 6 patients ovarian site pain(shift group(3 cases), shift + radiation and chemotherapy group 3 cases), pain in the abdomen and waist, the persistent pain, lasts for a few minutes to several hours, no periodic, can alleviate after rest, do not affect daily life. Ultrasound, CT and MRI are not shift ovarian cyst, displacement of ovarian tumor metastases and displacement of ovarian necrosis occurred. The rest of the patients with complete follow-up, through examination of department of gynaecology, vaginal stump blade, squamous cell nucleus antigen(SCCA) and ultrasound confirmed that no sign of cancer recurrence, shift ovarian had no metastasis.The study found that shift, shift + radiation and chemotherapy group and not shift + the number of cases of symptoms of the menopausal transition radiation and chemotherapy group respectively for 3(3/55) cases, 24(24/78) cases and 114 cases(102/102). Shift and shift + radiation and chemotherapy group, shift and shift + radiation and chemotherapy group and shift + between the radiation and chemotherapy group and shift + radiation and chemotherapy in Kupperman score, at the time of the last follow-up WHOQOL rating scale difference had statistical significance(P< 0.05). Shift at the last follow-up serum FSH, LH, E2 levels compared with hormone levels shift + radiation and chemotherapy group, the differences were statistically significant( P<0.05). Shift at the last follow-up serum FSH, LH, E2 levels compared with hormone levels not shift + radiation and chemotherapy group, the differences were statistically significant(P< 0.05). Shift + concurrent chemoradiation with shift + radiation and chemotherapy group at the last follow-up serum FSH, LH, E2 hormone level difference had statistical significance(P< 0.05).Conclusion:(1) Young patients with early cervical squamous carcinoma radical ovarian transposition is safe and feasible.(2) Ovarian transposition can avoid the function damage and improve the quality of life in some after the postopecative chemoradiation and radiotherapy.(3) Ovarian transportation cann‘t affect the ovarian function itself.(4) For young patients with cervical squamous carcinoma, radiotherapy on ovarian, can effectively protect the ovarian function, hot flashes, sweating, be agitated, vaginal dryness and the difficulty of sex, symptoms of menopause is pure radiation significantly reduced; E2 levels are significantly higher, pure radiation FSH and LH level was lower than those of pure radiotherapy, has yet to reach ovarian failure diagnostic criteria; And with ovary metastases, ovarian cyst, the risk of postoperative complications such as abdominal pain and did not increase.(5) Ovarian transposition are independent risk factors which affect ovarian function. Ovarian transposition can avoid radiation damage in young patients with cervical squamous carcinoma in some extent and improve menopausal symptoms, maintain normal ovarian function. |
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