輸卵管切除用于預(yù)防卵巢癌

1、1,Contents,輸卵管切除用于預(yù)防卵巢癌,2,美國婦產(chǎn)科醫(yī)師協(xié)會委員會在提出“切除輸卵管可能預(yù)防卵巢癌”這一觀點。Obstet Gynecol. 2015;125:279-281. Full textCommittee on Gynecologic Practice This document reflects emerging clinical and scientific advances as of the

2、date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.,,3,Counseling women who are undergoing routine pelvic surgery about

3、 the risks and benefits of salpingectomy should include an informed consent discussion about the role of oophorectomy and bilateral salpingo-oophorectomy.“The opinion specifically addresses women at "population ri

4、sk" for ovarian cancer, meaning women who do not have an elevated genetic risk for ovarian cancer but who are having routine pelvic surgery for benign disease.,,4,對于卵巢癌“大” 進行常規(guī)盆腔手術(shù)的女性，對于輸卵管切除風(fēng)險和好處的咨詢應(yīng)該包括卵巢切除術(shù)和雙側(cè)輸卵管切

5、除術(shù)的一個知情同意書。,,5,Salpingectomy at the time of hysterectomy or as a means of tubal sterilization appears to be safe, without an increase in complications...compared with hysterectomy alone or tubal ligation," the commi

6、ttee writes.婦產(chǎn)科醫(yī)師協(xié)會認為，與單純子宮切除術(shù)或輸卵管結(jié)扎術(shù)相比，在子宮切除時行輸卵管切除術(shù)或者輸卵管絕育術(shù)似乎是安全的，不會增加并發(fā)癥。,,6,n women considering laparoscopic sterilization, physicians can discuss the fact that bilateral salpingectomy provides effective contracept

7、ion, while pointing out that this procedure eliminates the option of tubal reversal. 對于考慮腹腔鏡絕育手術(shù)的婦女，醫(yī)生應(yīng)知會患者雙側(cè)輸卵管切除術(shù)可提供有效的避孕方法，同時指出這一手術(shù)后不可再行輸卵管復(fù)通術(shù)。,,7,婦科癌癥中，卵巢癌死亡率最高；在現(xiàn)在女性癌癥死亡率排名中已上升到第五名。卵巢癌存活率在最近 50 年中并沒有明顯改善,,8,More

8、randomized controlled trials are needed to support the use of salpingectomy in reducing ovarian cancer有關(guān)使用輸卵管切除術(shù)預(yù)防卵巢癌的做法，還需要更多的隨機對照試驗進行驗證。,,9,The committee urges surgeons to continue to use minimally invasive technique

9、s. For now, the possible benefit of salpingectomy should not sway decisions about which technique to use for hysterectomy and sterilization. For example, the committee advises surgeons not to switch from vaginal to lapar

10、oscopic hysterectomy simply to do a salpingectomy.委員會敦促醫(yī)生繼續(xù)使用微創(chuàng)手術(shù)。目前，輸卵管切除術(shù)可能的獲益還不能影響子宮切除術(shù)和結(jié)扎手術(shù)的技術(shù)決策。例如，例如委員會建議外科醫(yī)生不要僅僅為了做一個輸卵管切除術(shù)，而從陰道子宮切除術(shù)轉(zhuǎn)變?yōu)楦骨荤R子宮切除術(shù)。,,10,The latter techniques can cause early menopause and increased

11、 risk for cardiovascular disease, osteoporosis, and cognitive impairment and were also linked to increased risk for all-cause and cancer specific mortality in the Nurses' Health Study.后者會導(dǎo)致更年期提前，心血管疾病風(fēng)險增加，骨質(zhì)疏松和認知障礙，

12、并且在護士健康研究中發(fā)現(xiàn)，并與所有原因和癌癥死亡專率風(fēng)險增加有關(guān)。,,11,On the basis of current views about ovarian carcinogenesis, the committee continues, salpingectomy while leaving the ovaries intact may be better for cancer prevention than oophorect

13、omy and bilateral salpingo-oophorectomy. 基于目前有關(guān)卵巢癌變的觀點，委員會認為單純切除輸卵管，保留完整卵巢可能比卵巢切除術(shù)和雙側(cè)輸卵管、卵巢切除術(shù)預(yù)防癌癥的效果更好。,,12,he most compelling theory of epithelial ovarian carcinogenesis suggests that serous, endometrioid, and clear c

14、ell carcinomas are derived from the fallopian tube and the endometrium and not directly from the ovary (5–9). This is in contrast to the traditional view of ovarian carcinogenesis in which ovarian surface epithelium (mes

15、othelium) undergoes metaplastic changes leading to the different histologic types of epithelial ovarian cancer. In women with a genetic predisposition for ovarian cancer, lesions have been found in the fallopian tubes th

16、at closely resemble ovarian high-grade serous carcinomas or serous tubal intraepithelial carcinomas. These lesions are thought to be the primary source of ovarian carcinoma that secondarily involves the ovary. Genetics s

17、tudies show that these tubal lesions express a common TP53 mutation, as do high-grade serous, high-grade endometrioid, and undifferentiated carcinomas. In addition, gene expression of high-grade serous carcinom

18、as is more closely related to the fallopian tube morphology than the ovarian surface epithelium. High-grade serous carcinomas express a müllerian marker (PAX8) but not a mesothelial marker (calretinin).,13,委員會認為，大約

19、75% 的卵巢癌和 90% 的卵巢癌導(dǎo)致的死亡是由上皮性卵巢癌造成的。目前沒有可靠的卵巢癌篩查方案。傳統(tǒng)觀點認為上皮性卵巢癌起因于卵巢的一小部分，最新研究表明，上皮性卵巢癌源自輸卵管和子宮內(nèi)膜的一部分。研究還指出輸卵管結(jié)扎對子宮內(nèi)膜透明細胞癌起預(yù)防作用。,14,總結(jié)：基于女性中卵巢癌的人口風(fēng)險比例，外科醫(yī)生應(yīng)該對輸卵管切除術(shù)的潛在好處進行討論。在全子宮切除時，對于有卵巢癌風(fēng)險，希望保留卵巢的患者，討論切除輸卵管的利弊。3.

20、醫(yī)生應(yīng)該告知考慮腹腔鏡絕育手術(shù)的女性，雙側(cè)輸卵管切術(shù)可以提供有效避孕，并應(yīng)該指出這個手術(shù)還可以避免輸卵管扭轉(zhuǎn)這個疾病。4. 對于一些患者而言，預(yù)防性輸卵管切除術(shù)可能預(yù)防卵巢癌。,15,,16,,17,18,Click to edit headline,Competitors You may want to allocate one slide per competitor Strengths Your streng

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