臨床婦人科産科78巻9号

2024年09月発行

今月の臨床 ―外来担当医として知っておきたい―婦人科腫瘍の卵巣機能・妊孕性温存療法

子宮頸がん編

広汎子宮全摘出術で卵巣温存はどこまで許容されるか

著者： 太田剛¹

所属機関： ¹山形大学医学部産婦人科

ページ範囲：P.776 - P.782

文献概要

●広汎子宮全摘出術で卵巣温存を適応するには，卵巣転移のリスクを評価して安全性を担保する必要がある．

●50歳未満で子宮頸がんⅠB期の腺癌では卵巣温存を許容できる可能性がある．

●閉経前の患者に対する卵巣摘出は，健康障害が蓄積され，全生存率に悪影響を与える．

参考文献

1）日本婦人科腫瘍学会（編）: 子宮頸癌治療ガイドライン2022年度版．pp106-109，金原出版，2022

2）Matsuo K, et al : Identifying a candidate population for ovarian conservation in young women with clinical stage IB-IIB cervical cancer. Int J Cancer 142 : 1022-1032, 2018

3）Adelman MR, et al : Ovarian conservation vs removal at the time of benign hysterectomy. Am J Obstet Gynecol 218 : 269-279, 2018

4）Yasui T, et al : Factors associated with premature ovarian failure, early menopause and earlier onset of menopause in Japanese women. Maturitas 72 : 249-255, 2012

5）Ossewaarde ME, et al : Age at menopause, cause-specific mortality and total life expectancy. Epidemiology16 : 56-62, 2005

6）Rocca WA, et al : Survival patterns after oophorectomy in premenopausal women : a population-based cohort study. Lancet Oncol 7 : 21-28, 2006

7）Parker WH, et al : Long-term mortality associated with oophorectomy compared with ovarian conservation in the nurses' health study. Obstet Gynecol 121 : 709-716, 2013

8）Jacoby VL, et al : Oophorectomy vs ovarian conservation with hysterectomy : cardiovascular disease, hip fracture, and cancer in the Women's Health Initiative Observational Study. Arch Intern Med 171 : 60-68, 2011

9）Gierach GL, et al : Long-term overall and disease-specific mortality associated with benign gynecologic surgery performed at different ages. Menopause 21 : 592-601, 2014

10）Mytton J, et al : Removal of all ovarian tissue versus conserving ovarian tissue at time of hysterectomy in premenopausal patients with benign disease : study using routine data and data linkage. BMJ 356 : 372, 2017

11）Rocca WA, et al : Accelerated accumulation of multimorbidity after bilateral oophorectomy : a population-based cohort study. Mayo Clin Proc 91 : 1577-1589, 2016

12）Revera CM, et al : Increased cardiovascular mortality after early bilateral oophorectomy. Menopause 16 : 15-23, 2009

13）Parker WH, et al : Ovarian conservation at the time of hysterectomy for benign disease. Clin Obstet Gynecol 50 : 354-361, 2007