卵巢悬吊术后卵巢扭转坏死一例

doi:10.12280/gjfckx.20230345

摘要/Abstract

摘要：

年轻宫颈癌患者行卵巢悬吊术可保留卵巢功能，提高生活质量。鉴于目前国内外尚未形成统一标准的手术方式，术后卵巢扭转、卵巢囊肿等相关并发症偶有发生。回顾性分析2018年甘肃省妇幼保健院收治的1例ⅠA1期宫颈癌患者，为其实施腹腔镜下根治性子宫切除术+双侧卵巢悬吊术，术后3年因下腹痛再次入院，影像学评估为宫颈癌复发转移，经多学科诊疗讨论后行开腹探查术明确肿物性质，术后病理诊断为卵巢扭转坏死。结合文献进一步分析卵巢悬吊位置选择、术中注意事项及术后相关并发症等问题，以期为规范手术操作、早期识别、合理处理相关并发症提供参考及诊治经验。

关键词: 宫颈肿瘤, 妇科外科手术, 卵巢扭转, 诊断显像, 卵巢悬吊术

Abstract:

Ovarian suspension surgery can preserve ovarian function and improve quality of life in young patients with cervical cancer. In view of the fact that there is no unified standard surgical method at home and abroad, postoperative ovarian torsion, ovarian cyst and other related complications occasionally occur. A retrospective analysis was performed on a patient with stage cervical cancer admitted to Gansu Provincial Maternity and Child-Care Hospital in 2018. She underwent laparoscopic radical hysterectomy + bilateral ovary suspension surgery. She was re-admitted 3 years after the operation due to lower abdominal pain. The imaging assessment was recurrence and metastasis of cervical cancer. After discussion by multi-disciplinary team (MDT), laparotomy was performed to clarify the nature of the tumor. Postoperative pathological diagnosis was a case of ovarian torsion and necrosis. The selection of ovarian suspension location, intraoperative precautions, and postoperative complications were further analyzed in the light of the literature, in order to provide reference and experience in diagnosis and treatment for standardized surgical operations, early identification, and reasonable treatment of related complications.

Key words: Uterine cervical neoplasms, Gynecologic surgical procedures, Ovarian torsion, Diagnostic imaging, Ovarian suspension surgery

彭皓晨, 邵亚雯, 曹晓翠, 孙健豪, 吴珍珍. 卵巢悬吊术后卵巢扭转坏死一例[J]. 国际妇产科学杂志, 2023, 50(5): 559-562.

PENG Hao-chen, SHAO Ya-wen, CAO Xiao-cui, SUN Jian-hao, WU Zhen-zhen. A Case of Ovarian Torsion and Necrosis after Ovarian Suspension Surgery[J]. Journal of International Obstetrics and Gynecology, 2023, 50(5): 559-562.

图/表 3

参考文献 19

[1]	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]. CA Cancer J Clin, 2021, 71(3):209-249. doi: 10.3322/caac.21660.
[2]	Gu XY, Sun G, Zheng RS, et al. Incidence and mortality of cervical cancer in China in 2015[J]. J Nati Cancer Cent, 2022, 2(2):70-77. doi: 10.1016/j.jncc.2022.01.002.
[3]	中华人民共和国国家卫生健康委员会. 宫颈癌诊疗指南[EB/OL].(2022-04-03)[2023-01-19]. http://www.nhc.gov.cn/cms-search/downFiles/361f086b71214c4e8336fa7d251dc020.pdf.
[4]	Nguyen T, Cacciottola L, Camboni A, et al. Ovarian tissue cryopreservation and transplantation in patients with central nervous system tumours[J]. Hum Reprod, 2021, 36(5):1296-1309. doi: 10.1093/humrep/deaa353.
[5]	王敏, 陶陶, 王欣彦. 年轻早期宫颈癌患者手术保留卵巢相关问题[J]. 中国实用妇科与产科杂志, 2015, 31(6):503-507. doi: 10.7504/fk2015050107.
[6]	Morice P, Juncker L, Rey A, et al. Ovarian transposition for patients with cervical carcinoma treated by radiosurgical combination[J]. Fertil Steril, 2000, 74(4):743-748. doi: 10.1016/s0015-0282(00)01500-4. pmid: 11020517
[7]	胡明宗, 周本梅, 贾钰铭, 等. 对宫颈癌移位卵巢位点的初步研究[J]. 肿瘤预防与治疗, 2020, 33(1):28-32. doi: 10.3969/j.issn.1674-0904.2020.01.005.
[8]	Laios A, Duarte Portela S, Papadopoulou A, et al. Ovarian transposition and cervical cancer[J]. Best Pract Res Clin Obstet Gynaecol, 2021, 75:37-53. doi: 10.1016/j.bpobgyn.2021.01.013. pmid: 33715965
[9]	Laios A, Otify M, Papadopoulou A, et al. Outcomes of ovarian transposition in cervical cancer; an updated meta-analysis[J]. BMC Womens Health, 2022, 22(1):305. doi: 10.1186/s12905-022-01887-8. pmid: 35869476
[10]	Gómez-Hidalgo NR, Darin MC, Dalton H, et al. Ovarian torsion after laparoscopic ovarian transposition in patients with gynecologic cancer: a report of two cases[J]. J Minim Invasive Gynecol, 2015, 22(4):687-690. doi: 10.1016/j.jmig.2015.02.009.
[11]	Oyama K, Nakamoto K, Omori M, et al. Prognostication of Ovarian Function after Ovarian Torsion Using Intraoperative Indocyanine Green Angiography[J]. J Minim Invasive Gynecol, 2022, 29(2):237-242. doi: 10.1016/j.jmig.2021.08.003.
[12]	中国抗癌协会妇科肿瘤专业委员会. 子宫颈癌诊断与治疗指南(2021年版)[J]. 中国癌症杂志, 2021, 31(6):474-489. doi: 10.19401/j.cnki.1007-3639.2021.06.06.
[13]	Yen TC, Lai CH, Ma SY, et al. Comparative benefits and limitations of 18F-FDG PET and CT-MRI in documented or suspected recurrent cervical cancer[J]. Eur J Nucl Med Mol Imaging, 2006, 33(12):1399-1407. doi: 10.1007/s00259-006-0090-x.
[14]	Shuto K, Kono T, Shiratori T, et al. Diagnostic performance of diffusion-weighted magnetic resonance imaging in assessing lymph node metastasis of esophageal cancer compared with PET[J]. Esophagus, 2020, 17(3):239-249. doi: 10.1007/s10388-019-00704-w. pmid: 31820208
[15]	Peng NJ, Hu C, Chiu YL, et al. Detection of Recurrent Cervical Cancer and Prediction of Its Patient Survival with Serum Squamous-Cell Carcinoma-Antigen and 2-[¹⁸F] Fluoro-2-Deoxy-d-Glucose-Positron Emission Tomography/Computed Tomography[J]. Diagnostics (Basel), 2020, 10(9):657. doi: 10.3390/diagnostics10090657.
[16]	Qi C, He S, Cai L, et al. A study on the clinical value of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography combined with serum squamous cell carcinoma antigen in diagnosing recurrence/metastases in patients with early metaphase cervical cancer[J]. Oncol Lett, 2021, 22(5):746. doi: 10.3892/ol.2021.13007.
[17]	Chong A, Ha JM, Jeong SY, et al. Clinical Usefulness of ¹⁸F-FDG PET/CT in the Detection of Early Recurrence in Treated Cervical Cancer Patients with Unexplained Elevation of Serum Tumor Markers[J]. Chonnam Med J, 2013, 49(1):20-26. doi: 10.4068/cmj.2013.49.1.20. pmid: 23678473
[18]	Tian X, Ge D, Zhang F, et al. Dynamic analysis of circulating tumor DNA to predict prognosis and monitor therapeutic response in metastatic relapsed cervical cancer[J]. Int J Cancer, 2021, 148(4):921-931. doi: 10.1002/ijc.33362. pmid: 33113150
[19]	刘红红, 刘家金, 王瑞民, 等. ¹⁸F-FDG PET/MRI评估宫颈癌大小、分化程度、肌层浸润深度和周围组织受累[J]. 中国医学影像技术, 2021, 37(11):1619-1623. doi: 10.13929/j.issn.1003-3289.2021.11.006.