Contents1Introduction2Strategy3ChallengesForward4Conclusion1Contents1Introduction2Strategy輸卵管切除用于預防卵巢癌美國婦產科醫師協會委員會在提出“切除輸卵管可能預防卵巢癌”這一觀點。ObstetGynecol.2015;125:279-281.FulltextCommitteeonGynecologicPractice

Thisdocumentreflectsemergingclinicalandscientificadvancesasofthedateissuedandissubjecttochange.Theinformationshouldnotbeconstruedasdictatinganexclusivecourseoftreatmentorproceduretobefollowed.2輸卵管切除用于預防卵巢癌美國婦產科醫師協會委員會在Counselingwomenwhoareundergoingroutinepelvicsurgeryabouttherisksandbenefitsofsalpingectomyshouldincludeaninformedconsentdiscussionabouttheroleofoophorectomyandbilateralsalpingo-oophorectomy.“

Theopinionspecificallyaddresseswomenat"populationrisk"forovariancancer,meaningwomenwhodonothaveanelevatedgeneticriskforovariancancerbutwhoarehavingroutinepelvicsurgeryforbenigndisease.3Counselingwomenwhoare對于卵巢癌“大”進行常規盆腔手術的女性，對于輸卵管切除風險和好處的咨詢應該包括卵巢切除術和雙側輸卵管切除術的一個知情同意書。4對于卵巢癌“大”進行常規盆腔手術的女性，對于輸卵管切Salpingectomyatthetimeofhysterectomyorasameansoftubalsterilizationappearstobesafe,withoutanincreaseinparedwithhysterectomyaloneortuballigation,"thecommitteewrites.婦產科醫師協會認為，與單純子宮切除術或輸卵管結扎術相比，在子宮切除時行輸卵管切除術或者輸卵管絕育術似乎是安全的，不會增加并發癥。5Salpingectomyatthetimeofhnwomenconsideringlaparoscopicsterilization,physicianscandiscussthefactthatbilateralsalpingectomyprovideseffectivecontraception,whilepointingoutthatthisprocedureeliminatestheoptionoftubalreversal.對于考慮腹腔鏡絕育手術的婦女，醫生應知會患者雙側輸卵管切除術可提供有效的避孕方法，同時指出這一手術后不可再行輸卵管復通術。6nwomenconsideringlaparoscop

婦科癌癥中，卵巢癌死亡率最高；在現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77Morerandomizedcontrolledtrialsareneededtosupporttheuseofsalpingectomyinreducingovariancancer有關使用輸卵管切除術預防卵巢癌的做法，還需要更多的隨機對照試驗進行驗證。8MorerandomizedcontrollThecommitteeurgessurgeonstocontinuetouseminimallyinvasivetechniques.Fornow,thepossiblebenefitofsalpingectomyshouldnotswaydecisionsaboutwhichtechniquetouseforhysterectomyandsterilization.Forexample,thecommitteeadvisessurgeonsnottoswitchfromvaginaltolaparoscopichysterectomysimplytodoasalpingectomy.委員會敦促醫生繼續使用微創手術。目前，輸卵管切除術可能的獲益還不能影響子宮切除術和結扎手術的技術決策。例如，例如委員會建議外科醫生不要僅僅為了做一個輸卵管切除術，而從陰道子宮切除術轉變為腹腔鏡子宮切除術。9ThecommitteeurgessurgThelattertechniquescancauseearlymenopauseandincreasedriskforcardiovasculardisease,osteoporosis,andcognitiveimpairmentandwerealsolinkedtoincreasedriskforall-causeandcancerspecificmortalityintheNurses'HealthStudy.后者會導致更年期提前，心血管疾病風險增加，骨質疏松和認知障礙，并且在護士健康研究中發現，并與所有原因和癌癥死亡專率風險增加有關。10ThelattertechniquescancausOnthebasisofcurrentviewsaboutovariancarcinogenesis,thecommitteecontinues,salpingectomywhileleavingtheovariesintactmaybebetterforcancerpreventionthanoophorectomyandbilateralsalpingo-oophorectomy.基于目前有關卵巢癌變的觀點，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和雙側輸卵管、卵巢切除術預防癌癥的效果更好。11Onthebasisofcurrentviewshemostcompellingtheoryofepithelialovariancarcinogenesissuggeststhatserous,endometrioid,andclearcellcarcinomasarederivedfromthefallopiantubeandtheendometriumandnotdirectlyfromtheovary(5–9).Thisisincontrasttothetraditionalviewofovariancarcinogenesisinwhichovariansurfaceepithelium(mesothelium)undergoesmetaplasticchangesleadingtothedifferenthistologictypesofepithelialovariancancer.Inwomenwithageneticpredispositionforovariancancer,lesionshavebeenfoundinthefallopiantubesthatcloselyresembleovarianhigh-gradeserouscarcinomasorseroustubalintraepithelialcarcinomas.Theselesionsarethoughttobetheprimarysourceofovariancarcinomathatsecondarilyinvolvestheovary.Geneticsstudiesshowthatthesetuballesionsexpressacommon

TP53

mutation,asdohigh-gradeserous,high-gradeendometrioid,andundifferentiatedcarcinomas.Inaddition,geneexpressionofhigh-gradeserouscarcinomasismorecloselyrelatedtothefallopiantubemorphologythantheovariansurfaceepithelium.High-gradeserouscarcinomasexpressamüllerianmarker(PAX8)butnotamesothelialmarker(calretinin).12hemostcompellingtheoryofe委員會認為，大約75%的卵巢癌和90%的卵巢癌導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膜的一部分。研究還指出輸卵管結扎對子宮內膜透明細胞癌起預防作用。13委員會認為，大約75%的卵巢癌和90

總結：基于女性中卵巢癌的人口風險比例，外科醫生應該對輸卵管切除術的潛在好處進行討論。在全子宮切除時，對于有卵巢癌風險，希望保留卵巢的患者，討論切除輸卵管的利弊。3.醫生應該告知考慮腹腔鏡絕育手術的女性，雙側輸卵管切術可以提供有效避孕，并應該指出這個手術還可以避免輸卵管扭轉這個疾病。4.對于一些患者而言，預防性輸卵管切除術可能預防卵巢癌。

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