妊娠期间宫颈癌52例临床分析

Clinical analysis of 52 cases of cervical cancer during pregnancy

目的全国多中心回顾性总结分析妊娠期间宫颈癌患者的临床特点及治疗方法。方法回顾性分析2009年1月至2017年7月来自北京、上海、浙江、河南、江西、贵州、山西、江苏、重庆、湖南、辽宁、海南等13家医院共52例妊娠合并宫颈癌患者的病例资料,分析其临床特点、筛查特点及处理。结果 （1）妊娠期宫颈癌在同期妊娠人群中发病率为0.016%（52/330 138例）,在宫颈癌中的发病率为0.24%（52/21 311）,患者平均年龄33岁,发现宫颈癌在早期妊娠中占28.8%（15/52例）,中晚期妊娠占71.2%（37/52例）。宫颈癌IA1占3.9%（2/52例）,IB1期以上占92.3%（48/52例）。（2）因阴道不规则出血为主诉者占90.7%（39/43例）。73.1%（38/52例）的患者孕检或妊娠期间未进行过细胞学检查。63.5%（33/52例）的患者5年以上从未进行过宫颈癌筛查。（3）早期妊娠者全部选择终止妊娠后治疗宫颈癌;中期妊娠者6例选择保留胎儿,其中包括2例行广泛宫颈切除手术＋剖宫产术,2例行新辅助化疗（NACT）后＋剖宫产术＋宫颈癌根治术,1例行新辅助化疗后＋剖宫产术＋同步放化疗,1例保胎至28周行剖宫产术＋宫颈癌根治术;晚期妊娠者79.2%促胎肺成熟后剖宫产终止妊娠＋后续宫颈癌治疗,平均终止孕周36周。结论妊娠期间宫颈癌多在妊娠中晚期发现;多为宫颈癌FIGO中晚期;多数5年内未进行过筛查。妊娠期间宫颈癌患者,多选择终止妊娠后治疗宫颈癌。在妊娠中期进行新辅助化疗至胎儿成熟,终止妊娠后治疗宫颈癌是可行的。

Objective To summarize and analyze the clinical characteristics and the treatment of cervical cancer during pregnancy.Method 52 cases of cervical cancer during pregnancy from 13 hospitals including Beijing,Shanghai,Zhejiang,Henan,Jiangxi,Guizhou,Shanxi,Jiangsu,Chongqing,Hunan,Liaoning and Hainan were analyzed retrospectively.Results（1） Fifty two patients out of 21 311 cases（0.24%） of invasive cervical cancer and out of 330 138 pregnant women（0.016%）were diagnosed.The Mean age is 33 years old.28.8% of cervical cancer was found on the first trimester,71.2% on the second and third trimester of the pregnancy.The International Federation of Gynecology and Obstetrics（FIGO） stage IA1 accounted for 3.9%,and IB1 above was 92.3%.（2） 90.7% of cases presented with irregular bleeding in the vagina.73.1% of the patients had no cytological examination performed during or before the pregnancy.63.5% of the patients had never been screened for more than five years.（3） All of the cervical cancer with first trimester terminate the pregnancy.Six cases of cervical cancer with second trimester keep the fetus,with two cases of radical trachelectomy plus cesarean section,two cases of NACT＋cesarean section＋radical hysterectomy,one case of NACT＋cesarean section＋concurrent chemoradiotherapy,One case of cesarean section＋radical hysterectomy in 28 week pregnancy.In the late trimester of pregnancy,79.2% of patients were treated after the cesarean section until fetal maturity,the average week of termination of gestation was 36 weeks.Conclusions Cervical cancer during pregnancy are more often found in the middle and late trimester of pregnancy,mostly presented in the middle and advanced stage of cervical cancer,and most of which haven＇t been screened for cervical cancer within five years.Most cases of cervical cancer during pregnancy treated after termination of pregnancy.In the middle of trimester,NACT is proposed until fetal maturity followed by surgical staging after delivery.