早期宫颈癌保留生育功能不同手术方式的妊娠及肿瘤结局——单中心10年回顾性分析

Pregnancy and oncologyic outcomes with different surgical procedures for fertility preservation in early cervical cancer:10-year retrospective analysis in a single-center

目的探讨不同分期和风险早期宫颈癌适宜的保留生育功能处理策略。方法回顾分析2010年1月到2019年12月在陆军军医大学第一附属医院妇科住院部诊断为早期宫颈癌并接受保留生育功能手术的60例患者的临床资料,其中行广泛子宫颈切除术+盆腔淋巴结切除术28例、单纯子宫颈切除术7例和宫颈锥切术25例,术中同时行宫颈环扎23例。分析患者的临床病理情况,追踪随访生育情况及肿瘤预后。分析有生育意愿患者的妊娠率,观察手术远期并发症,统计术中同时行宫颈环扎患者的宫颈狭窄发生率。结果60例行保留生育功能手术的早期宫颈癌患者中,6.7%(4/60)术后出现复发,死亡率5%(3/60)。宫颈切除组无复发患者,广泛宫颈切除组与宫颈锥切组复发率分别为10.7%和6.7%。复发患者主要为Ib1期伴深肌层浸润。治疗后计划妊娠的23例患者中,6例成功妊娠(26.1%),其中3例足月分娩(宫颈锥切组1例,广泛宫颈切除组2例)。常见远期并发症为严重的宫颈粘连和狭窄。术中环扎者4例(17.4%,4/23),未环扎者2例(5.4%,2/37),两者发生率差异无统计学意义(P=0.191)。结论不同分期和风险的早期宫颈癌需选择适宜保留生育功能的手术方式,有中风险因素者需强调术后辅助治疗,减少复发转移风险。

Objective:To explore the appropriate management strategy for fertility preservation in different stage and risk of early cervical cancers.Methods:The datas of fertility preservation for early cervical cancer were collected from January 2010 to December 2019 in the First Affiliated Hospital of Army Military Medical University.All patient were follow-up regularly after operation.The patients were divided into three groups according to surgical methods:extensive cervical with pelvic lymph node resection group(28),simple cervical resection group(7),cervical conical resection group(25).There were 23 cases treated with ligation during the operation.The clinicopathological factor and outcome were analyzed retrospectively.The pregnancy rate(patients with fertility intention)and long-term complications were observed,as well as the incidence of cervical stenosis in simultaneous cervical ring ligature during surgery.Results:A total of 60 patients were enrolled,6.7%(4/60)of the patients had recurrence,and the death rate was 5.0%(3/60).There was no recurrence in the cervical resection group.The recurrence rate in the extensive cervical resection group was 10.7%while the cervical conical resection group was 6.7%,no difference between the two groups.The main recurrence factors were Ib1 stage with deep myometrial invasion.Among the 23 patients who planned pregnancy after treatment,6 cases were pregnant(26.1%),including 3 cases with full-term delivery.Long-term postoperative complication were severe cervical adhesion and stenosis with dilation treatment.There were no difference when 4 cases(17.4%,4/23)in ligation treatment and 2 cases(5.4%,2/37)in un-ligation(P=0.191).Conclusion:The optimal fertility preservation surgery should be adopted for patients with early cervical cancer according to different risks and stages.To reduce the recurrence and metastasis,those patients with intermediate risk factors should be accepted postoperative adjuvant therapy.