输卵管切除用于预防卵巢癌课件

Contents1Introduction2Strategy3ChallengesForward4Conclusion1Contents1Introduction2Strategy输卵管切除用于预防卵巢癌美国妇产科医师协会委员会在提出“切除输卵管可能预防卵巢癌”这一观点。ObstetGynecol.2015;125:279-281.FulltextCommitteeonGynecologicPractice

Thisdocumentreflectsemergingclinicalandscientificadvancesasofthedateissuedandissubjecttochange.Theinformationshouldnotbeconstruedasdictatinganexclusivecourseoftreatmentorproceduretobefollowed.2输卵管切除用于预防卵巢癌美国妇产科医师协会委员会在Counselingwomenwhoareundergoingroutinepelvicsurgeryabouttherisksandbenefitsofsalpingectomyshouldincludeaninformedconsentdiscussionabouttheroleofoophorectomyandbilateralsalpingo-oophorectomy.“

Theopinionspecificallyaddresseswomenat"populationrisk"forovariancancer,meaningwomenwhodonothaveanelevatedgeneticriskforovariancancerbutwhoarehavingroutinepelvicsurgeryforbenigndisease.3Counselingwomenwhoare对于卵巢癌“大”进行常规盆腔手术的女性，对于输卵管切除风险和好处的咨询应该包括卵巢切除术和双侧输卵管切除术的一个知情同意书。4对于卵巢癌“大”进行常规盆腔手术的女性，对于输卵管切Salpingectomyatthetimeofhysterectomyorasameansoftubalsterilizationappearstobesafe,withoutanincreaseinparedwithhysterectomyaloneortuballigation,"thecommitteewrites.妇产科医师协会认为，与单纯子宫切除术或输卵管结扎术相比，在子宫切除时行输卵管切除术或者输卵管绝育术似乎是安全的，不会增加并发症。5Salpingectomyatthetimeofhnwomenconsideringlaparoscopicsterilization,physicianscandiscussthefactthatbilateralsalpingectomyprovideseffectivecontraception,whilepointingoutthatthisprocedureeliminatestheoptionoftubalreversal.对于考虑腹腔镜绝育手术的妇女，医生应知会患者双侧输卵管切除术可提供有效的避孕方法，同时指出这一手术后不可再行输卵管复通术。6nwomenconsideringlaparoscop

妇科癌症中，卵巢癌死亡率最高；在现在女性癌症死亡率排名中已上升到第五名。卵巢癌存活率在最近50年中并没有明显改善77Morerandomizedcontrolledtrialsareneededtosupporttheuseofsalpingectomyinreducingovariancancer有关使用输卵管切除术预防卵巢癌的做法，还需要更多的随机对照试验进行验证。8MorerandomizedcontrollThecommitteeurgessurgeonstocontinuetouseminimallyinvasivetechniques.Fornow,thepossiblebenefitofsalpingectomyshouldnotswaydecisionsaboutwhichtechniquetouseforhysterectomyandsterilization.Forexample,thecommitteeadvisessurgeonsnottoswitchfromvaginaltolaparoscopichysterectomysimplytodoasalpingectomy.委员会敦促医生继续使用微创手术。目前，输卵管切除术可能的获益还不能影响子宫切除术和结扎手术的技术决策。例如，例如委员会建议外科医生不要仅仅为了做一个输卵管切除术，而从阴道子宫切除术转变为腹腔镜子宫切除术。9ThecommitteeurgessurgThelattertechniquescancauseearlymenopauseandincreasedriskforcardiovasculardisease,osteoporosis,andcognitiveimpairmentandwerealsolinkedtoincreasedriskforall-causeandcancerspecificmortalityintheNurses'HealthStudy.后者会导致更年期提前，心血管疾病风险增加，骨质疏松和认知障碍，并且在护士健康研究中发现，并与所有原因和癌症死亡专率风险增加有关。10ThelattertechniquescancausOnthebasisofcurrentviewsaboutovariancarcinogenesis,thecommitteecontinues,salpingectomywhileleavingtheovariesintactmaybebetterforcancerpreventionthanoophorectomyandbilateralsalpingo-oophorectomy.基于目前有关卵巢癌变的观点，委员会认为单纯切除输卵管，保留完整卵巢可能比卵巢切除术和双侧输卵管、卵巢切除术预防癌症的效果更好。11Onthebasisofcurrentviewshemostcompellingtheoryofepithelialovariancarcinogenesissuggeststhatserous,endometrioid,andclearcellcarcinomasarederivedfromthefallopiantubeandtheendometriumandnotdirectlyfromtheovary(5–9).Thisisincontrasttothetraditionalviewofovariancarcinogenesisinwhichovariansurfaceepithelium(mesothelium)undergoesmetaplasticchangesleadingtothedifferenthistologictypesofepithelialovariancancer.Inwomenwithageneticpredispositionforovariancancer,lesionshavebeenfoundinthefallopiantubesthatcloselyresembleovarianhigh-gradeserouscarcinomasorseroustubalintraepithelialcarcinomas.Theselesionsarethoughttobetheprimarysourceofovariancarcinomathatsecondarilyinvolvestheovary.Geneticsstudiesshowthatthesetuballesionsexpressacommon

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mutation,asdohigh-gradeserous,high-gradeendometrioid,andundifferentiatedcarcinomas.Inaddition,geneexpressionofhigh-gradeserouscarcinomasismorecloselyrelatedtothefallopiantubemorphologythantheovariansurfaceepithelium.High-gradeserouscarcinomasexpressamüllerianmarker(PAX8)butnotamesothelialmarker(calretinin).12hemostcompellingtheoryofe委员会认为，大约75%的卵巢癌和90%的卵巢癌导致的死亡是由上皮性卵巢癌造成的。目前没有可靠的卵巢癌筛查方案。传统观点认为上皮性卵巢癌起因于卵巢的一小部分，最新研究表明，上皮性卵巢癌源自输卵管和子宫内膜的一部分。研究还指出输卵管结扎对子宫内膜透明细胞癌起预防作用。13委员会认为，大约75%的卵巢癌和90

总结：基于女性中卵巢癌的人口风险比例，外科医生应该对输卵管切除术的潜在好处进行讨论。在全子宫切除时，对于有卵巢癌风险，希望保留卵巢的患者，讨论切除输卵管的利弊。3.医生应该告知考虑腹腔镜绝育手术的女性，双侧输卵管切术可以提供有效避孕，并应该指出这个手术还可以避免输卵管扭转这个疾病。4.对于一些患者而言，预防性输卵管切除术可能预防卵巢癌。

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