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据最新临床研究发现表明，在实行子宫切除手术同时摘除卵巢并非利大于弊。为此纽约时报专门以保留卵巢让妇女活得更长为题发表了文章。以下是该文的编译报道。
每年，有成千上万名妇女经受手术切除术，在切除子宫的同时也摘除卵巢，目的是为了防止得卵巢癌。但新的研究表明保留卵巢的妇女通常寿命更长。统计数据表明，妇女除去子宫后，其优点是可以在手术后的未来24年中，彻底消除卵巢癌的风险同时减少发生乳腺癌的发生概率。但是，摘除卵巢的妇女比保留卵巢的妇女更容易发生心脏病，更容易发生死亡。
这是通过对护士进行的健康研究调查发现以上现象和结论。这一研究在五月刊的美国妇产科杂志上发表。这一发现，引发了人们对摘除卵巢这一常规医疗手段产生质疑。在美国每年有30万妇女因种种妇科疾病而施行子宫摘除术，其中半数的妇女选择接受同时摘除其卵巢。
这一论文的通讯作者，来自美国加州Santa Monica市John Wayne肿瘤研究所的William H. Parker博士告诉媒体. “这些事实与过去35年来妇科教学中的观点是背道而驰的。”
早在上世纪七十年代，医学界就达成共识，摘除卵巢预防卵巢癌是新的治疗策略。但新的研究发现表明，摘除卵巢可能增加妇女的死亡率，除非你是属于发生高危卵巢癌发生几率的家庭。卵巢癌通常很难早期诊断，一旦发现通常已晚而且有很高的致死率。
在上述的研究中发现，参加这项研究中那些保留卵巢的妇女只有34％死于卵巢癌。但心脏病每年导致高达20多倍的妇女死亡。这项涉及24年长期追踪的临床研究，共有29380位施行子宫摘除术的妇女参加这项追踪调查，其中第一组中有16345名妇女摘除了双侧卵巢，第二组有13035位妇女保留其卵巢。
24年之后，第一组中，有895名妇女得了乳腺癌，这比第二组保留子宫的妇女要低25％的乳腺癌发生几率。只有五例得了卵巢癌，比第二组保留卵巢妇女的低95％概率。但第一组的妇女在24年的随访期内，死亡率要比第二组高12％。第一组妇女发生心脏病风险要比第二组高17％，癌症死亡率也要高出17％。在那些50岁前就摘除卵巢和子宫，同时又不服用雌激素的妇女，发生死亡率和心脏病风险的概率要比同时实行子宫摘除术但保留卵巢的妇女高好多。
这项研究还再度引发关于使用雌激素在心脏病预防方面作用的争议，Parker博士和其他专家们认为，保留卵巢的妇女之所以活得更长是因为，卵巢在女性进入更年期后产生雌激素的量减少。这时的卵巢产生雄烯二酮和睾酮，这些物质被脂肪和肌肉转换成雌激素。
当然，这一发现并不表示，切除卵巢不可取。哈佛医学院教授，麻省总医院妇产科主任Isaac Schiff博士指出，这一新的研究发现并不表明或支持这样的观点。是否摘除卵巢要看具体情况。对于有家族卵巢癌和乳腺癌病史的人来说，应该考虑同时摘除卵巢。医生应该给予病人相关的信息和选择。让患者明白什么是她最好的选择。在过去，他给病人的选择和建议并非如此，他通常会告诉病人，加入你已经过了45岁，他会建议摘除患者的卵巢。
评论：这一发现的确很重要，给妇女提供更合理的选择。完成这一研究课题的学者们很有耐心和毅力，对大量的临床数据进行长期而系统的追踪调查。如果没有各方配合协作，要完成这么大型的长期研究。
原文：
Women Who Keep Ovaries Live Longer
Each year, hundreds of thousands of women who undergo hysterectomieshave their ovaries removed along with their uterus, a practice meant to protect them from ovarian cancer. But a new study has found that women who keep their ovaries live longer.
The new findings — from an analysis of data in the famous Nurses’ Health Study, published in the May issue of the journal Obstetrics & Gynecology — raises questions about a widespread practice. Some 300,000 American women a year, about half of those who have hysterectomies, have their ovaries removed.
“This finding is contrary to 35 years of teaching in gynecology,” said the lead author, Dr. William H. Parker of the John Wayne Cancer Institute in Santa Monica, Calif.
“In the 1970s, it was decided that taking out the ovaries to prevent ovarian cancer would be the new strategy,” he said. “This study shows that you’re more likely to die if you have your ovaries taken out, unless you’re among a group of women with a family history that places you at high risk for ovarian cancer or breast cancer.”
While ovarian cancer is difficult to detect and often deadly, it is also rare, Dr. Parker explained, noting that only 34 of the study participants who kept their ovaries died of ovarian cancer during the follow-up period. “Heart disease kills more than 20 times the number of women every year,” he said.
The study analyzed data on 29,380 women who had participated in the Harvard Nurses’ Health Study: 16,345 who had hysterectomy with both ovaries removed, and 13,035 who had hysterectomy but kept their ovaries.
After 24 years of follow-up, women in the first group had 895 cases of breast cancer — a 25 percent lower risk than those who kept their ovaries — and 96 percent less risk of ovarian cancer (just 5 cases). But they were 12 percent more likely to die during the follow-up period. Their risk of heart disease was 17 percent higher than the risk faced by women with ovaries. They also had a 17 percent greater risk of dying of cancer. And in an unexpected finding, they were at greater risk for lung cancer.
The risks of heart disease and death appeared to be even greater for women who had their uterus and ovaries removed before age 50 and did not take estrogen, compared with women who had a hysterectomy before 50 but kept their ovaries.
The study may add to the debate over estrogen and the role it plays in heart disease in women. Dr. Parker and other experts suggested that women who kept their ovaries lived longer because even though the ovaries make less estrogen after menopause, they produce androstenedione and testosterone, which are converted into estrogen by fat and muscle.
Dr. Isaac Schiff, chief of obstetrics and gynecology at Massachusetts General Hospital and a professor at Harvard School of Medicine, said the study did not mean that women undergoing hysterectomies should never have their ovaries removed.
“A woman with a strong family history of ovarian cancer or breast cancer should still be given the option of having her ovaries removed,” said Dr. Schiff, who was not involved in the study. “The individual patient should be given the information, and decide what’s best for her.”
But that is a change from the past, he said, adding, “We used to just arbitrarily say, ‘If you’re over 45, have your ovaries taken out.’
