生殖医学杂志

目的探讨卵巢上皮性交界性肿瘤(BOTs)的临床病理特点及影响预后的相关危险因素,评价保留生育功能手术治疗后患者的妊娠结局。方法回顾性分析首都医科大学附属北京妇产医院及北京市平谷区医院1998年8月至2013年8月间收治的254例BOTs患者的临床病理资料。根据手术方式不同及是否保留生育功能,将患者分为保守性手术组和非保守性手术组、开腹手术组和腹腔镜手术组,比较各组患者的妊娠结局。结果 254例患者初次发病的中位年龄为36岁,术后随访6~180个月。保守性手术组的复发率(19.11%)显著高于非保守性手术组(2.06%);开腹手术组复发率(9.91%)显著低于经腹腔镜手术组(26.19%);年龄≤40岁组复发率(19.08%)显著高于>40岁组(2.94%);交界性粘液性肿瘤组复发率(8.62%)显著低于交界性浆液性肿瘤组(17.24%);肿瘤直径≤10cm组复发率(6.19%)显著低于直径>10cm组(17.73%)(P均<0.05)。多因素分析发现保守性手术、交界性浆液性肿瘤、经腹腔镜手术是肿瘤复发的独立高危因素(P<0.05)。有生育要求的57例患者中术后妊娠34例,妊娠率59.65%,保守分期性手术组的妊娠率(54.54%)与肿瘤剔除或单侧附件切除组(60.86%)比较无显著性差异(P>0.05)。结论 BOTs患者行保守性手术和经腹腔镜手术后易复发,且病例分型为交界性浆液性肿瘤的患者复发风险相对较大,临床治疗时要综合考虑患者情况,对无生育要求的患者建议行全面分期性手术。保守性手术中手术范围增大是否会影响术后的妊娠率,尚需大样本的研究证实。

Objective: To explore the clinical pathological characteristics of borderline ovarian tumors(BOTs)and the risk factors related recurrence,and evaluate pregnancy outcome after preserving fertility surgery.Methods: The clinical data of 254 BOTs patients from Beijing Maternity Hospital and the Hospital of Pinggu District,Beijing from August 1998 to August 2013 were retrospectively analyzed.The patients were divided into conservative and non-conservative surgery group,as well as laparotomy and laparoscopic surgery group according to whether retain reproductive function.The effects of clinical pathological characteristics upon recurrence were analyzed by independent sample test,Chi-square test,and Cox proportional hazard model.Results: The median age of onset in 254 patients was 36 years old.The time of follow-up was 6to180 months.The recurrence rate(19.11%)in conservative surgery group were significantly higher thannon-conservative surgery group(2.06%)(P<0.05).The recurrence rate in laparotomy surgery group(9.91%)was significantly lower than that in laparoscopic surgery group(26.19%)(P <0.05).The recurrence rate in≤40years of age group(19.08%)was significantly higher than that in>40years of age group(2.94%)(P<0.05).The relapse rate in borderline mucinous tumor(8.62%)was significantly lower than that in borderline serous tumor group(17.24%)(P<0.05).The relapse rate in the tumor with diameter≤10cm group(6.19%)was significantly lower than diameter>10cm group(17.73%)(P<0.05).Multivariate analysis showed that conservative surgery,borderline serous tumor,and laparoscopic surgery were the independent risk factors for tumor recurrence(P <0.05).Thirty four pregnancies occurred in 57 patients with fertility requirement,and pregnancy rate was 59.65%.The pregnancy rate in the conservative staging surgery group(54.54%)was not significantly different with in tumor removed or unilateral oophorectomy group(60.86%)(P>0.05).Conclusions: The BOTs patients after conservative surgery and laparoscopic surgery were easy to elapse,and the recurrence risk is relatively higher in the patients with borderline serous tumor.The comprehensive staging surgery should be recommended for the patients without fertility requirements.The large samples are needed to confirm whether the increase of operation range in the conservative surgery affects the pregnancy rate.