妊娠合并子宫颈癌37例分析

Clinical analysis of 37 cases of cervical cancer complicating pregnancy and the literature review

目的分析妊娠合并子宫颈癌的临床特点、治疗及预后,探讨妊娠合并子宫颈癌各临床病理因素对预后的影响。方法回顾性分析2012年1月至2017年11月山东大学齐鲁医院收治的37例妊娠合并子宫颈癌患者的临床病理资料,分析妊娠合并子宫颈癌患者的临床及病理特点、终止妊娠方式、治疗方案及随访情况。并采用Kaplan-Meier法、log-rank检验进行统计学分析。结果37例患者中,早孕期患者5例确诊后即选择终止妊娠,并开始肿瘤治疗;中孕期患者6例中除1例外均一经诊断即选择放弃妊娠,行子宫颈癌治疗;晚孕期的6例在确诊后即选择行剖宫产分娩,共分娩6例新生儿,存活5例,死亡1例。3例患者剖宫产娩出新生儿后行肿瘤根治术。分娩后6个月内确诊患者共20例,其中剖宫产12例,经阴道分娩7例,引产1例(胎儿畸形)。37例患者中25例无瘤生存,12例疾病进展死亡。单因素分析结果提示:肿瘤大小、淋巴结转移、间质浸润深度、病理类型、淋巴脉管间隙浸润是影响预后的主要因素(P<0.05)。结论妊娠合并子宫颈癌的预后取决于临床分期及诊治时间,预后差的患者多数发现时期别晚,故应强调孕前与妊娠期的子宫颈癌筛查的重要性。

Objective To analyze the clinical characteristics,treatment and prognosis of cervical cancer complicating preganacy,and to explore the influence of clinico-pathological factors on the prognosis of pregnancy with cervical cancer.Methods The clinico-pathological data of 37 pregnant women with cervical cancer admitted to Qilu Hospital of Shandong University from January 2012 to November 2017 were analyzed retrospectively.Then the clinical and pathological features of patients with cervical cancer in different pregnancy periods,as well as the ways of terminating pregnancy,the treatment options and the follow-up were analyzed.Kaplan-Meier method and log-rank test were used for statistical analysis.Results Of the 37 patients,5 cases who were diagnosed with cervical cancer in the first trimester all chose to terminate the pregnancy and began tumor treatments as soon as possible;6 cases were diagnosed in the second trimester,among which five chose to give up pregnancy and started cervical cancer treatment;6 cases received cesarean section to terminate the pregnancy after diagnosis in the third trimester,and 3 of them underwent radical abdominal hysterectermy in the meantime;6 neonates were delivered,5 survived and 1 died.Twenty patients were diagnosed within 6 months after delivery,including 12 cases of caesarean section deliveries,7 cases of vaginal delivery,and 1 case of induction delivery because of fetal anomaly.Among the 37 patients,25 survived,12 died due to disease progression.Univariate analysis suggested that,tumor size,depth of interstitial invasion,lymph node metastasis,vascular invasion and pathological type were the main factors affecting the prognosis of patients(P<0.05).Conclusion The prognosis of cervical cancer complicating pregnancy depends on the clinical stage and diagnosis and treatment time.Patients with poor prognosis are mostly found in the late stage of cervical cancer.Therefore,cervical cancer screening before and during pregnancy is very important.