【作者】 周建丽；

【导师】 蒋凤艳；

【作者基本信息】 广西医科大学 ， 妇产科学， 2010， 硕士

【摘要】 目的:探讨乳腺癌辅助化疗对月经影响的因素,为保护化疗患者的卵巢功能提供理论依据。方法:收集自2005年5月至2009年5月广西医科大学第一附属医院乳腺外科住院病人乳腺癌患者165例,全部进行手术治疗,病理确诊为乳腺癌,术后辅助全身化疗。观察患者治疗前后的月经情况以及围绝经期症状等。结果:1. 165例乳腺癌患者中,化疗后有108例患者(65.45%)出现闭经,50(30.30%)例出现月经紊乱,7(4.24%)例月经无明显变化。闭经患者中60例(55.55%)恢复月经,其中54例(50.0%)在停药后2-12个月内恢复,6例(5.55%)在13-18个月恢复,48例(44.44%)随访到2010年2月未恢复月经,30(27.28%)例出现围绝经期的症状,主要为潮热、出汗、烦躁、性生活不满意等症状。2.闭经组开始化疗的年龄为30～48岁,平均年龄40.81±3.89岁,月经紊乱组开始化疗的年龄为26～39岁,平均年龄33.90±3.42岁,月经规则组开始化疗的年龄为25～37岁,平均年龄30.57±4.93岁。闭经组开始化疗的年龄大于月经紊乱组及月经正常组,p<0.05;月经紊乱组开始化疗的年龄与月经正常组无差异,p>0.05。3.采用CAF方案123例,闭经78例,闭经率63.4%;采用TE方案42例,有30例闭经,闭经率为71.4%,p>0.05。4.采用CAF方案及TE方案的患者随环磷酰胺及紫杉醇累积剂量的增加,闭经的人数也增加。5.闭经组血清卵泡刺激素(follicle stimulating hormone,FSH)、黄体生成素(1uteinizing hormone,LH)水平明显高于未闭经组患者,雌二醇(estrodio,E2)水平明显低于未闭经组患者,p均<0.05。结论:化疗药物可导致患者月经改变。化疗对月经的影响跟开始化疗时患者年龄、药物的累积剂量有关,跟化疗方案无关。为保护化疗患者的卵巢功能尽量选择药物剂量小对卵巢功能损害少的化疗药,选用合适的方法保护患者的生育功能。更多还原

【Abstract】 OBJECTIVE: Adjuvant chemotherapy for breast cancer influence on menstrual factors, for the protection of ovarian function in patients with chemotherapy to provide evidence.METHODS: 165 cases were collected from May 2005 to May 2009 the First Affiliated Hospital of Guangxi Medical University, breast surgery patients, patients with breast cancer confirmed by pathology in our hospital with systemic adjuvant chemotherapy refers to disease and indication. Aged 25-48 years, mean age was 41.13 years old, the normal treatment period, no other system tumors and diseases, and has not taken within six months of hormone drugs. Observation period as well as in patients with perimenopausal symptoms, analyze the impact of chemotherapy-induced abnormal menstrual factors, in order to reduce the damage of chemotherapy on ovarian function to provide evidence.RESULT: 1.165 cases of breast cancer, chemotherapy, 108 patients (65.45%) amenorrhea, 50 (30.30%) patients had menstrual disorders, 7 (4.24%) cases no significant changes in menstruation. Amenorrhea, 60 cases (55.55%) resumed menstruation, in which 54 patients (50.0%) 2-12 months after stopping the rehabilitation of 6 cases (5.55%) recovery in 13-18 months, 48 patients (44.44% ) up to February 2010 not to resume menstruation, 30 (27.28%) patients had perimenopausal symptoms, mainly hot flashes, sweating, irritability, sexual dissatisfaction and other symptoms. 2. Amenorrhea group began chemotherapy at the age of 30 to 48 years, mean age 40.81±3.89 years, menstrual disorder and began chemotherapy at the age of 26 to 39 years old, mean age 33.90±3.42 years, the rules set period began chemotherapy at the age of 25 37 years old, mean age 30.57±4.93 years. Amenorrhea group began chemotherapy, age greater than normal menstrual disorder group and the group’s average age of menstruation, by group t test, p <0.05; menstrual disorder and began chemotherapy in the control group of age and menstrual age of starting chemotherapy, t test, p> 0.05, not significant. 3. CAF program with 123 cases, 78 cases of amenorrhea, amenorrhea rate of 63.4%; with 42 cases of TE programs, there are 30 cases of amenorrhea, amenorrhea rate was 71.4%, two by theχ2 test, p> 0.05, no significant difference. 4. Using CAF programs and TE program and paclitaxel in patients with cumulative cyclophosphamide dose increased, the number of menopause also increased, p<0.05, significant difference. 5. Amenorrhea serum FSH (follicle stimulating hormone, FSH), luteinizing hormone (1uteinizing hormone, LH) levels were significantly higher than patients without amenorrhea, estradiol (estrodio, E2) levels were significantly lower than patients without amenorrhea , p <0.05.CONCHLSIONS: Chemotherapy drugs can cause menstrual changes. The impact of chemotherapy on the period beginning chemotherapy in patients with age, cumulative dose of drugs, nothing to do with chemotherapy. For the protection of ovarian function in patients with chemotherapy drug of choice as far as possible on the ovarian function of small doses of chemotherapy drugs less damage, choose the appropriate ways to protect the patient’s reproductive function. Whether the use of chemotherapy in patients with postmenopausal HRT replacement therapy remains controversial. .更多还原