Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 170

Repositioning the ovaries out of the irradiation field can preserve ovarian function and should be considered in women of reproductive age with pelvic malignancies or before pelvic lymph node irradiation. This can be unilateral or bilateral and carried out via laparotomy or laparoscopy. The proper location to fix the transposed ovaries depends on the planned irradiation field. For cervical cancer the ovaries are transposed high and lateral above the pelvic brim, while for pelvic lymph node irradiation (as in Hodgkin’s lymphoma) the ovaries can be medially or laterally transposed. Complications of the procedure are rare but include chronic pelvic pain, vascular injury, fallopian tube infarction and ovarian migration. For patients with external pelvic (45 Gy) irradiation with or without para‐aortic nodal irradiation (45 Gy), the amount of radiation received by the ovaries with lateral transposition (mean distance 14.4cm) was calculated to be 1.26Gy for intracavitary radiation, whereas for external pelvic with or without para‐aortic nodal irradiation the dose was 1.35–1.90 and 2.30–3.10 Gy, respectively [10]. Ovarian function preservation rates with a median follow up of 31 months were 100% for patients treated exclusively by surgery, 90% for those treated with vaginal brachytherapy and surgery, and 60% for those treated with pelvic irradiation and vaginal brachytherapy.