早期宫颈癌保留生育功能手术的治疗效果及妊娠结局

doi:10.6040/j.issn.1671-7554.0.2018.227

摘要/Abstract

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

周慧梅,杨佳欣,曹冬焱,沈铿,向阳,吴鸣,潘凌亚,黄惠芳,郎景和. 早期宫颈癌保留生育功能手术的治疗效果及妊娠结局[J]. 山东大学学报 (医学版), 2018, 56(5): 18-22.

ZHOU Huimei, YANG Jiaxin, CAO Dongyan, SHEN Keng, XIANG Yang, WU Ming, PAN Lingya, HUANG Huifang, LANG Jinghe. Fertility-sparing radical trachelectomy for young women with early stage cervical cancer: surgical and obstetrical outcomes[J]. Journal of Shandong University (Health Sciences), 2018, 56(5): 18-22.

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