输卵管切除用于预防卵巢癌.ppt

1,Contents,输卵管切除用于预防卵巢癌,2,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。 Obstet Gynecol. 2015;125:279-281. Full text Committee on Gynecologic Practice This document reflects emerging clinical and scientific advances as of the 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 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 risk“ 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,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。,5,Salpingectomy at the time of hysterectomy or as a means of tubal sterilization appears to be safe, without an increase in pared with hysterectomy alone or tubal ligation,“ the committee writes. 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。,6,n women considering laparoscopic sterilization, physicians can discuss the fact that bilateral salpingectomy provides effective contraception, while pointing out that this procedure eliminates the option of tubal reversal. 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。,7,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,8,More randomized controlled trials are needed to support the use of salpingectomy in reducing ovarian cancer 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。,9,The committee urges surgeons to continue to use minimally invasive techniques. 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 laparoscopic hysterectomy simply to do a salpingectomy. 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。,10,The latter techniques can cause early menopause and increased 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。,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 oophorectomy and bilateral salpingo-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。,12,he most compelling theory of epithelial ovarian carcinogenesis suggests that serous, endometrioid, and clear cell carcinomas are derived from the fallopian tube and the endometrium and not directly from the ovary (59). This is in contrast to the traditional view of ovarian carcinogenesis in which ovarian surface epithelium (mesothelium) 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 that 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 studies 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 carcinomas is more closely related to the fallopian tube morphology than the ovarian surface epithelium. High-grade serous carcinomas express a mllerian marker (PAX8) but not a mesothelial marker (calretinin).,13,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。,14,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。,15,16,17,18,Click to edit headline,Competitors You may want to allocate one slide per competitor Strengths Your strengths relative to competitors Weaknesses Your weaknesses relative to competitors,19,Click to edit headline,2004,2003,2002,2001,step1,step1,step1,step1,20,Click to edit headline,Conclusion 1,Conclusion 2,Click to edit your subject 1,Click to edit your subject 1,Click to edit your subject 1,Click to edit your subject 2,Click to edit your subject 2,Click to edit your subject 2,21,Click to edit headline,Click to edit your text,Click to edit your text,Click to edit your text,22,Click to edit headline,Example 03,Example 04,subject,23,Click to edit headline,Click to edit text,Click to e