您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2018, Vol. 56 ›› Issue (5): 18-22.doi: 10.6040/j.issn.1671-7554.0.2018.227

• • 上一篇    

早期宫颈癌保留生育功能手术的治疗效果及妊娠结局

周慧梅,杨佳欣,曹冬焱,沈铿,向阳,吴鸣,潘凌亚,黄惠芳,郎景和   

  1. 中国医学科学院北京协和医学院 北京协和医院妇产科, 北京 100730
  • 收稿日期:2018-02-14 发布日期:2022-09-27
  • 通讯作者: 杨佳欣. E-mail:YangJiaXin@pumch.cn
  • 基金资助:
    国家科技部十一五国家科技支撑计划(2008BAI57B02)

Fertility-sparing radical trachelectomy for young women with early stage cervical cancer: surgical and obstetrical outcomes

ZHOU Huimei, YANG Jiaxin, CAO Dongyan, SHEN Keng, XIANG Yang, WU Ming, PAN Lingya, HUANG Huifang, LANG Jinghe   

  1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science &
    Peking Union Medical College, Beijing 100730, China
  • Received:2018-02-14 Published:2022-09-27

PDF (PC)

21

摘要： 目的 探讨早期宫颈癌患者接受保留生育功能的腹腔镜辅助的根治性宫颈切除术(LARVT)的肿瘤治疗效果及妊娠结局。 方法 选择2003年1月至2017年1月在中国医学科学院北京协和医院诊断为早期宫颈癌并接受LARVT治疗的患者88例,收集临床资料,记录有关影响因素,回顾性分析临床病理参数、肿瘤随访结果及妊娠结局。 结果 患者平均30.9岁(18~44岁),组织学类型包括鳞癌68例,腺癌14例,腺鳞癌3例,透明细胞癌3例。按国际妇产科联合会(FIGO)分期,ⅠA1期5例,ⅠA2期8例,ⅠB1期75例。肿瘤直径≤2 cm患者76例,>2 cm患者12例。术后随访时间平均为54.1个月(2.0~176.9个月)。11例患者复发,复发中位时间34.1个月(9.3~90.1个月),复发率12.5%。40例患者根治性宫颈切除术后有生育计划,其中17例患者共获妊娠21例次,活产15例。 结论 LARVT是治疗早期宫颈癌的一种有效术式,可为年轻的早期宫颈癌患者保留生育能力,其手术的安全性与有效性仍然需要长期的临床观察和验证。

关键词: 宫颈肿瘤, 根治性宫颈切除术, 保留生育能力, 腹腔镜检查, 肿瘤复发,局部, 妊娠结局

Abstract: Objective To evaluate the surgical and obstetrical outcomes of patients with early stage cervical cancer who underwent laparoscopic-assisted radical vaginal trachelectomy(LARVT). Methods A retrospective analysis was performed including young women with stage ⅠA1 and stage ⅠB1 cervical cancer who were treated with LARVT at the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital from January 2003 to January 2017. Results Eighty-eight patients with early stage cervical cancer(ⅠA1, n=5; ⅠA2, n=8; ⅠB1, n=75)were selected as candidates for the inclusion criteria during the period analyzed. The patients’ average age was 30.9 years(range, 18-44 years). Histology included 68 cases with squamous cell carcinoma, 14 cases with adenocarcinoma, 3 cases with adeno-squamous carcinoma, and 3 cases with clear cell carcinoma. Twelve patients(13.7%)had a tumor >2 cm and 76 cases had a tumor ≤ 2 cm. The median duration of follow-up reached 54.1 months(2.0-176.9 months). Eleven patients(12.5%)had recurrent diseases. The median interval between the initial surgery and recurrence was 34.1 months(range, 9.3-90.1 months). A total of 40 patients had attempted to conceive, resulting in 21 pregnancies and 15 healthy babies. Conclusion LARVT should be offered as an alternative treatment for women with early stage cervical cancer who want to preserve their fertility. The oncologic outcome and pregnancy outcome should be further investigated for long-term follow-up.

Key words: Cervical cancer, Radical trachelectomy, Fertility preservation, Laparoscopy, Neoplasm recurrence, local, Pregnancy outcome

中图分类号: 

  • R713.4
[1] Dargent D, Brun JL, Roy M, Remy I. Pregnancies following radical trachelectomy for invasive cervical cancer[J]. Gynecol Oncol, 1994, 54(2): 105.
[2] KimJH, Park JY, Kim DY, et al. Fertility-sparing laparoscopic radical trachelectomy for young women with early stage cervical cancer[J]. BJOG, 2010, 117(3): 340-347.
[3] Persson J, Kannisto P, Bossmar T. Robot-assisted abdominal laparoscopic radical trachelectomy[J]. Gynecologic Oncology, 2008, 111(3): 564-567.
[4] 沈铿, 郎景和, 杨佳欣, 等. 腹腔镜阴式广泛性子宫颈切除术治疗早期子宫颈癌的临床分析[J]. 中华妇产科杂志, 2006, 41(4): 222-225. SHEN Keng, LANG Jinghe, YANG Jiaxin, et al. Analysis of 16 patients with early cervical cancer treated by laparoscopic vaginal radical trachelectomy[J]. Chin J Obstet Gynecol, 2006, 41(4): 222-225.
[5] 曹冬焱,杨佳欣,向阳,等. 早期子宫颈癌患者行阴式子宫颈广泛性切除术的治疗效果及生育结局[J]. 中华妇产科杂志, 2014, 49(4): 249-253. CAO Dongyan, YANG Jiaxin, XIANG Yang, et al. Oncologic and fertility outcomes of young patients with early stage of cervical cancer treated by vaginal radical trachelectomy[J]. Chin J Obstet Gynecol, 2014, 49(4): 249-253.
[6] Smith JR, Boyle DC, Corless DJ. Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma[J]. Br J Obstet Gynaecol, 1997, 104(10): 1196-1200.
[7] Diaz JP, Sonoda Y, Leitao MM, et al. Oncologic outcome of fertility-sparing radical trachelectomy versus radical hysterectomy for stage IB1 cervical carcinoma[J]. Gynecol Oncol, 2008, 111(2): 255-260.
[8] Abu-Rustum NR, Sonoda Y, Black D, et al. Fertility-sparing radical abdominal trachelectomy for cervical carcinoma: technique and review of the literature[J]. Gynecol Oncol, 2006, 103(3): 807-813.
[9] National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cervical cancer[EB/OL].[2018-04-02]. Version 1. 2018. https://www.nccn.org/professionals/physician_gls/default.aspx#site.
[10] Lintner B, Saso S, Tarnai L, et al. Use of abdominal radical trachelectomy to treat cervical cancer greater than 2 cm in diameter[J]. Int J Gynecol Cancer, 2013, 23(6): 1065-1070.
[11] Wethington SL, Sonoda Y, Park KJ, et al. Expanding the indications for radical trachelectomy: a report on 29 patients with stage IB1 tumors measuring 2 to 4 centimeters[J]. Int J Gynecol Cancer, 2013, 23(6): 1092-1098.
[12] Lanowska M, Mangler M, Speiser D, et al. Radical vaginal trachelectomy after laparoscopic staging and neoadjuvant chemotherapy in women with early-stage cervical cancer over 2 cm: oncologic, fertility, and neonatal outcome in a series of 20 patients[J]. Int J Gynecol Cancer, 2014, 24(3): 586-593.
[13] Baiocchi G, de Brot L, Faloppa CC. Is parametrectomy always necessary in early-stage cervical cancer?[J]. Gynecol Oncol, 2017, 146(1): 16-19.
[14] Schneider A, ErdemogluE, Chiantera V, et al. Clinical recommendation radical trachelectomy for fertility preservation in patients with early-stage cervical cancer[J]. Int J Gynecol Cancer, 2012, 22(4): 659-666.
[15] Peters III WA, Liu PY, Barrett II RJ, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix[J]. J Clin Oncol, 2000, 18(8): 1606-1613.
[16] Sedlis A, Bundy BN, Rotman MZ, et al. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a Gynecologic Oncology Group study[J]. Gynecol Oncol, 1999, 73(2): 177-183.
[17] Cao DY, Yang JX, Wu XH, Comparisons of vaginal and abdominal radical trachelectomy for early-stage cervical cancer: preliminary results of a multi-center research in China[J]. Br J Cancer, 2013, 109(11): 2778-2782.
[18] Noyes N, AbuRustum NR, Ramirez PT, et al. Options in the management of fertility-related issues after radical trachelectomy in patients with early cervical cancer[J]. Gynecol Oncol, 2009, 114(1): 117-120.
[19] Beiner ME, Hauspy J, Rosen B, et al. Radical vaginal trachelectomy vs. radical hysterectomy for small early stage cervical cancer: a matched case-control study[J]. Gynecol Oncol, 2008, 110(2): 168-171.
[20] Lloyd PA, Briggs EV, Kane N, et al. Womens experiences after a radical vaginal trachelectomy for early stage cervical cancer. A descriptive phenomenological study[J]. Eur J Oncol Nurs, 2014, 18(4): 362-371.
[21] Li X, Li J, Wu X. Incidence, risk factors and treatment of cervical stenosis after radical trachelectomy: a systematic review[J]. Eur J Cancer, 2015, 51(13): 1751-1759.
[22] Park JY, Kim DY, Suh DS, et al. Reproductive outcomes after laparoscopic radical trachelectomy for early-stage cervical cancer[J]. J Gynecol Oncol, 2014, 25(1): 9-13.
[23] Kim CH, Abu-Rustum NR, Chi DS, et al. Reproductive outcomes of patients undergoing radical trachelectomy for early-stage cervical cancer[J]. Gynecol Oncol, 2012, 125(3): 585-588.
[1] 吴日超,刘红,王泽,高姗姗,李秀芳,石玉华. 40岁及以上女性行体外受精-胚胎移植助孕的妊娠结局分析[J]. 山东大学学报 (医学版), 2022, 60(6): 35-39.
[2] 邬晓琳,李萍. 激动剂长方案下促性腺激素使用时长对体外受精胚胎移植妊娠结局的影响[J]. 山东大学学报 (医学版), 2021, 59(7): 32-37.
[3] 邓晓惠,徐亚瑄. 高龄女性生育力评估及辅助生育[J]. 山东大学学报（医学版）, 2017, 55(1): 5-10.
[4] 杨冬梓,麦卓瑶. 高龄多囊卵巢综合征患者的卵巢储备特点及其助孕结局[J]. 山东大学学报（医学版）, 2017, 55(1): 26-32.
[5] 王遥,崔国英,王飞,李长忠. 人类白细胞抗原-E在宫颈癌中的表达及意义[J]. 山东大学学报（医学版）, 2016, 54(9): 59-63.
[6] 张湛,许相丰,刘海东,王玮. MRI在宫颈癌T分期中的诊断价值[J]. 山东大学学报（医学版）, 2016, 54(5): 70-73.
[7] 彭慧,何君梅,苏雪莲. 血清循环miR-375检测对宫颈癌早期诊断及术后监测的意义[J]. 山东大学学报（医学版）, 2016, 54(3): 68-71.
[8] 田馨莉, 矫俊, 张腾, 马道新, 崔保霞. Th22细胞联合Th17细胞在宫颈癌外周血中的表达及意义[J]. 山东大学学报（医学版）, 2015, 53(7): 43-47.
[9] 刘亚飞, 张奇舒, 袁首道, 陈健行. HPV永生化细胞系与SiHa细胞系蛋白质表达差异的质谱分析[J]. 山东大学学报（医学版）, 2015, 53(3): 22-26.
[10] 李晨, 程玉峰, 李爱禄. 妇科门诊女性人乳头瘤病毒感染型别分布特征及临床分析[J]. 山东大学学报（医学版）, 2015, 53(11): 73-76.
[11] 宗丽菊, 张友忠, 王颉, 吴淑霞, 刘洪丽, 张璐. 四甲基吡啶卟啉-光动力疗法对人宫颈永生化上皮H8细胞的作用[J]. 山东大学学报（医学版）, 2015, 53(1): 21-26.
[12] 王颉, 张友忠, 冯进波, 刘洪丽, 宗丽菊. 慢病毒介导的hTERT-shRNA联合光动力治疗对宫颈癌细胞SiHa的影响[J]. 山东大学学报（医学版）, 2015, 53(1): 27-33.
[13] 张演亮1，庄子荣2,朱琳1，梁婷婷1. 宫颈癌患者腹腔镜术后生存质量调查[J]. 山东大学学报（医学版）, 2014, 52(6): 62-66.
[14] 王立葵, 桑洪爱, 马玉燕, 徐银涛, 王琳琳. 66例系统性红斑狼疮患者67次妊娠特点及妊娠结局分析[J]. 山东大学学报（医学版）, 2014, 52(12): 69-72.
[15] 孙高英1，王小元2，张晓金1，郝秀玉1，郭元芳1，王晓1，毕文祥1. N-乙酰半胱氨酸对子宫颈癌细胞紫杉醇耐药性的影响[J]. 山东大学学报(医学版), 2013, 51(3): 42-47.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发