妊娠合并宫颈癌母胎结局7例分析

Clinical analysis of 7 patients with cervical cancer in pregnancy

目的总结妊娠合并宫颈癌临床特点、诊治及母婴预后。探讨保留胎儿治疗方法的临床价值。方法回顾性分析中山大学孙逸仙纪念医院2005年1月至2013年3月收治的7例妊娠合并宫颈癌患者临床资料及随访结果。结果6例为单胎妊娠，1例为双胎妊娠。ⅠB1期1例，ⅠB2～ⅡA期5例，ⅡB期1例。鳞癌6例，腺癌1例。2例患者行胎儿在宫内的广泛全子宫切除，1例患者行放射治疗。4例患者要求保留胎儿，其中1例延期治疗8d，3例采用顺铂联合紫杉醇新辅助化疗，均于孕33～33“周行剖宫产加根治性手术。患者中位无瘤生存期为45个月。新生儿均未见明显畸形和生长发育异常。结论妊娠期应注意宫颈病变筛查。妊娠合并宫颈癌应结合临床分期、妊娠周数、生育意愿等制定个体化治疗方案。孕期顺铂联合紫杉醇新辅助化疗加剖宫产后根治性手术可能是妊娠合并宫颈浸润癌并要求保留胎儿患者的一种新的治疗选择，值得进一步临床研究。

Objective To investigate the characteristics, diagnosis, treatment and prognosis of cervical cancer in pregnan- cy and discuss new managements of fetal-sparing. Methods The clinical data of 7 cases with cervical cancer in pregnancy between January 2005 and March 2013 were analyzed retrospectively. Results Six patients are single pregnancy and one patient is twin pregnancy. There was 1 case of I B1,5 cases of I B2- II A and 1 case of II B. Six patients were squa- mous cell carcinoma while one was adenocarcinoma. Two patients accepted the treatment with a radical hysterectomy with fetus in situ, one patient received radiation while four others desired to continue their pregnancies. Among them, one patient chose to delay the operative treatment for 8 days. Three of them were treated with cisplatin plus paclitaxel as neoadjuvant chemotherapy until fetal pulmonary maturity was achieved and then accepted a cesarean section followed by radical hysterectomy at a range of 33 to 33 ＋6weeks of gestation. The median disease-free survival was 45months. All neonates were healthy and no abnormalities were found up to date. Conclusions It is necessary to make the screening of cervical lesions in prenatal examination. There are different options of treatment which can be discussed on the basis of several factors such as tumor stage, gestational age, and the patient＇s desire regarding fertility and pregnancy sparing. Neoadjuvant chemotherapy with paclitaxel and platinum followed by cesarean section and radical surgery is an innovative approach for selective pregnant women with invasive cervical cancer and more studies are required.