Ovarian Transposition And Vaginal Extension In Young Patients With Early Cervical Cancer

Background and ObjectiveCervical cancer ranks the first among the three gynecological malignancies,which has become an important hidden danger threatening the safety and health of women.In recent years,Studies at home and abroad indicate that the mortality of the disease gradually decreases,but the trend of younger age of cervical cancer is bocoming more prominent.Surgery,chemotherapy and radiotherapy are the main treatment options for cervical cancer.The treatment of young patients with early cervical should not only improve the prognosis,but also try to meet the needs of patients and their spouses for postoperative sex life and ensure the quality of postoperative life.Therefore,it is of great clinical significance to improve the prognosis of young patients with early cervical cancer.Our hospital will be less than40 years old,normal ovarian function and cervical cancer patients with earlier clinical stages(stage IB1~IIA)called early young patients with cervical cancer,designed not to affect long-term survival under the premise,ovarian transposition and vaginal extension were evaluated and actively performed at the same time ofcervical cancer radical operation,continuously improve the quality of life in young patients with cervical cancer early.Research objective:Can the ovarian transposition in young patients with early cervical cancer better protect ovaries from radiation therapy andmaintain relatively normal hormone levels in women?Whether vaginal extension can prolong the vaginal length of young patients with early cervical cancer and improve postoperative sexual quality of patients?Materials and Methods1.Clinical data:Retrospectively analyse the patients with early cervical cancer aged 40 years or younger with normal ovarian function from January 2011 to January2015 at the first affiliated hospital of gynaecology of zhengzhou university,according to the international union of gynecology and obstetrics(FIGO)staging cervical cancer clinical staging standard,their clinical stages were all in stage IB1~IIA.Preoperative pathology confirmed 86 cases of squamous cell carcinoma and 12 cases of adenocarcinoma.The patients were divided into 4 groups according to the surgical treatment.Group A: 31 patients with cervical squamous cell carcinoma underwent laparoscopic extensive hysterectomy + pelvic lymph node dissection + bilateral ovarian marker displacement +vaginal extension.Group B: 25 patients with cervical squamous cell carcinoma underwent laparoscopic extensive hysterectomy + pelvic lymph node dissection + bilateral ovarian marker transposition.Group C: 30 patients with cervical squamous cell carcinoma underwent laparoscopic extensive hysterectomy + pelvic lymph node dissection + bilateral ovary titanium clip labeling and displacement + vaginal extension + postoperative radiotherapy.Group D: 12 patients with cervical adenocarcinoma underwent laparoscopic extensive hysterectomy + pelvic lymph node dissection + bilateral adnexectomy +vaginal extension.In this study,the preoperative age,vaginal length and ovarian function of all patients were not statistically significant(P>0.05).All patients were followed for 3years without any tumor recurrence or death.2.Observation indicators:All patients successfully completed the 3-year follow-up,and no patient died,and during the follow-up process,the results of various examinations during the patient's return showed that obvious signs of tumor recurrence and metastasis were excluded.During the follow-up period,the results of all examinations during the patient's return visit excluded the obvious signs of tumorrecurrence and metastasis.In this study,four groups of patients were followed up regularly to record their overall postoperative quality of life,such as their living conditions,to score the patients by the perimenopause comprehensive scale,to measure vaginal depth;and to detect FSH,LH,and E2 levels of ovarian,and to evaluate the postoperative sexual quality of patients by the female sexual function index(FSFI).3.Statistical methods:SPSS 17.0 software was used for statistical analysis,and the measurement data were expressed as `X±S.ANOVA was used for the comparison between groups,and P<0.05 was considered statistically significant,while LSD-test was used for the comparison between groups,and P<0.05 was considered statistically significant.Results1.Postoperative life status:All patients successfully completed the surgery,and no tumor recurrence or metastasis occurred during the 3-year follow-up.All patients were rated annually in the perimenopause comprehensive scale(Kupperman standard1995).The score of each group was expressed as ` X±S.The Kupperman scores of patients in group A were the lowest,and those in group D were the highest,and the difference was statistically significant(1 to 3 year after the operation : P <0.05).Postoperative life status scores of group A and group B were not statistically significant(1 year after surgery:P > 0.05;2 years after surgery :P > 0.05;3 years after surgery :P > 0.05),Kupperman scores of group A were slightly lower than those of group C and D,and the differences were statistically significant(both were: 1 year after surgery :P < 0.05;2 years after surgery :P < 0.05;3 years after surgery :P <0.05).Postoperative life status score of group C was lower than that of group D,and the difference was statistically significant(1 to 3 year after surgery:P < 0.05).2.Vaginal length:All patients underwent gynecological examination and TCT smear every year after surgery without obvious abnormalities.Vaginal length,that is,the distance from the vaginal opening to the posterior fornix or vaginal stump,was measured annually before and during postoperative follow-up.The vaginal length ofeach group was expressed as`X±S.Preoperative vaginal length of each group was not statistically significant(P > 0.05).Vaginal length was measured again every year when patients were followed up on admission.The postoperative vaginal length of group A was statistically significant compared with that of group B,C and D(both were:1 year after surgery:P < 0.05;2 years after surgery :P < 0.05;3 years after surgery :P < 0.05),the vaginal length of group A was longer than that of the other three groups,especially the vaginal atrophy of group D was obvious 3 years after surgery.3.Ovarian hormone levels:The blood levels of FSH(follicle-stimulating hormone)(mIU/ml),LH(luteinizing hormone)(mIU/ml)and E2(estrogen)(pg/ml)were determined by radioimmunoassay before and one year after the operation.The ovarian hormone levels of each group was expressed as`X±S.The results showed that the preoperative hormone levels in each group were not statistically significant(FSH:P > 0.05,LH:P > 0.05,E2:P > 0.05).One year after the operation,the values of reproductive hormones FSH,LH and E2 in group A and group B were basically normal,and there was no statistical significance between the two groups(FSH:P >0.05,LH:P > 0.05,E2:P > 0.05).The hormone levels in group A were statistically significant compared with those in group C and D(both were:FSH:P < 0.05,LH:P <0.05,E2:P < 0.05).The levels of FSH and LH in group A were lower than those in group C and D,and the levels of E2 in group A were higher than those in group C and D.The difference of hormone levels between group C and group D was statistically significant(FSH:P < 0.05,LH:P < 0.05,E2:P < 0.05).FSH and LH in group C were significantly lower than those in group D,and E2 values were significantly higher than those in group D.4.Sexual quality:All patients returned to normal sexual life within 1 year after surgery,and no tumor recurrence or death occurred during 3-year follow-up.Female sexual function scale(FSFI)was used annually during the follow-up period to evaluate the postoperative sexual function of each group.The score of each group was expressed as ` X±S.The results showed that the FSFI scores of postoperative sexual quality in group A,group B,group C and group D were statistically significant 1~3years after the operation(all values: 1 year after the operation: P < 0.05;2 years aftersurgery:P < 0.05;3 years after surgery:P < 0.05),FSFI score was the highest in group A and the lowest in group D.Group C was lower than group A and B(both were: 1year after surgery,P < 0.05;2 years after surgery :P < 0.05;3 years after surgery :P <0.05),but the score of group C was significantly higher than that of group D(both were: 1~3 years after surgery :P < 0.05).Conclusion1.For young patients with cervical cancer,ovary displacement can basically maintain the normal ovarian function,under the action of radiotherapy,the function of displaced ovary can be affected to a certain extent,but it can still maintain a certain level of ovarian hormone,and improve the overall quality of life of the patient.2.For young patients with cervical cancer,vaginal extension during the operation can improve the postoperative sexual quality of the patients,thus improving the overall quality of life of the patients.3.For young patients with cervical cancer,ovary displacement and vaginal extension do not increase the risk of cancer recurrence and metastasis in the future,so it is a safe,effective and worthy of promotion.