妊娠期间宫颈癌20例临床分析

Clinical Analysis of 20 Cases of Cervical Cancer During Pregnancy

目的分析妊娠期间宫颈癌患者的临床资料与母胎结局,对其诊疗方案进行归纳总结。方法分析2010年5月至2020年12月就诊于山东大学齐鲁医院的20例妊娠期间宫颈癌患者的临床资料,分析临床特点及治疗方法。结果20例患者发病平均年龄(32.7±4.13)岁,其中早孕期6例(30.00%),中孕期7例(35.00%),晚孕期7例(35.00%),所有早孕期患者均选择终止妊娠并行根治手术,7例中孕期宫颈癌患者中有2例选择新辅助化疗延长孕周,其中1例术后1年因肿瘤复发死亡,1例预后良好,2例幼儿均发育正常;7例晚孕期患者中3例因个人因素或其他产科因素初次手术仅行剖宫产,4例行剖宫产+根治性手术,其中5例胎儿随访结局良好。结论早孕期宫颈癌患者继续妊娠等待时间过长,疾病进展风险大,早期宫颈癌患者可谨慎的考虑终止妊娠+保留生育功能的宫颈癌根治术。妊娠期新辅助化疗对母胎是相对安全的,中孕期综合考虑孕周、病理类型、分期、生育愿望等因素可先行新辅助化疗,待胎儿相对成熟后行剖宫产+根治性手术,晚孕期患者也可考虑新辅助化疗,在32~34周后考虑剖宫产终止妊娠。

Objective To analyze the clinical data and maternal-fetal outcome of patients with cervical cancer during pregnancy,so as to summarize their diagnosis and treatment plans.Methods The clinical data of 20 patients with cervical cancer during pregnancy who were admitted to Qilu Hospital of Shandong University from May 2010 to December 2020 were analyzed retrospectively,analyze clinical characteristics and treatment methods.Results The mean average age of the 20 patients was(32.7±4.13)years old,6 of them were in early pregnancy(30.00%),7 of them were in middle pregnancy(35.00%),and 7 of them were in late pregnancy(35.00%).All patients in early pregnancy chose to terminate pregnancy and admitted radical surgery.2 of the 7 patients with cervical cancer in the middle trimester chose neoadjuvant chemotherapy.Among them,1 patient died of cancer recurrence 1 year after surgery,the other one had a good prognosis,and both children of them had normal development;among the 7 patients in the third trimester,3 patients only underwent cesarean section for the first time operation due to personal factors or other obstetric factors,and 4 patients underwent cesarean section followed by radical surgery.Among them,5 fetuses had good follow-up results.Conclusion Patients with cervical cancer in early pregnancy wait too long to continue pregnancy,and the risk of disease progression is high.Patients with early cervical cancer can carefully consider termination of pregnancy and admit surgery that preserves fertility.Neoadjuvant chemotherapy during pregnancy is relatively safe for the mother and the fetus.During the second trimester,neoadjuvant chemotherapy can be performed after comprehensive consideration of the patient's gestational age,pathological type,stage,and fertility desire.After the fetus is relatively mature,cesarean section followed by radical surgery will be performed.Patients during pregnancy can also consider neoadjuvant chemotherapy,and consider cesarean section to terminate pregnancy after 32-34 weeks.