摘要
目的探讨妊娠合并宫颈癌的临床特点、孕期管理、分娩时机与治疗原则。方法回顾北京大学人民医院2014年9月至2023年1月收治的13例妊娠合并宫颈癌患者临床资料,分析其孕周、肿瘤病理特征、终止妊娠时机、治疗方案及母胎预后,为临床诊治提供参考依据。结果(1)共入组妊娠合并宫颈癌患者13例,平均年龄(32.15±4.79)岁。孕中期诊断7例(53.85%)、孕晚期5例(38.46%)、产后1例(7.69%),平均确诊孕周23+3周,平均终止孕周35^(+1)周。早期宫颈癌共10例(76.92%);(2)临床表现为阴道不规则出血,主要病理类型为腺癌及鳞癌;(3)孕中期7例患者均因强烈生育意愿继续保胎治疗,其中4例行新辅助化疗,平均化疗次数2.5次,紫杉醇+卡铂为一线化疗方案。均促胎肺成熟后限期剖宫产+宫颈癌后续治疗。孕晚期4例患者确诊后即刻行剖宫取胎+宫颈癌后续治疗,1例患者要求继续期待治疗,后因胎膜早破终止妊娠。余1例患者拒绝孕期完善阴道镜活检,产后确诊行宫颈癌根治术;(4)所有患者随访至今母胎结局良好。结论妊娠合并宫颈癌患者趋于高龄;多在妊娠中晚期诊断,延误时间较长,应增强孕前/早孕期TCT+高危型HPV联合筛查;临床分期多为早期;多数患者保留胎儿意愿强烈,需结合患者意愿及临床特点开展个体化治疗;孕期盆腔MR平扫及应用新辅助化疗具有安全可行性。
Objective To explore the clinical characteristics,pregnancy management,delivery time and treatment principles of pregnancy with cervical cancer.Methods The clinical data of 13 pregnant patients with cervical cancer admitted to Peking University People's Hospital from September 2014 to January 2023 were reviewed to analyze their gestational age,tumor pathological features,pregnancy termination time,treatment as well as maternal and fetal prognosis,providing reference for clinical diagnosis and therapy.Results①A total of 13 pregnant women with cervical cancer were enrolled,with an average age of(32.15±4.79)years.There were 7 cases diagnosed in the second trimester(53.85%),5 cases in the third trimester(38.46%),and 1 case in the postpartum(7.69%).The average gestation week was 23+3 weeks,while the average age of termination of pregnancy was 35^(+1) weeks.There were 10 cases of early cervical cancer,accounting for 76.92%.②The clinical manifestations were irregular vaginal bleeding,while the main pathological types were adenocarcinoma and squamous carcinoma.③All the 7 patients in the second trimester of pregnancy decided to undergo expectant treatment due to strong fertility intention,in which four of them received neoadjuvant chemotherapy.The average frequency of chemotherapy was 2.5 times,and paclitaxel+carboplatin was the first-line chemotherapy regimen.All received cesarean section within a limited period after fetal lung maturation,followed with hysterectomy and adjuvant therapy.In the third trimester of pregnancy,4 patients received caesarean section and follow-up treatment for cervical cancer immediately after diagnosis,and 1 patient requested to continue to expect treatment,then terminated pregnancy because of premature rupture of fetal membranes.Besides,1 patient refused to complete colposcopic biopsy during pregnancy,and was diagnosed to undergo radical hysterectomy after delivery.④All patients had good maternal and fetal outcomes.Conclusions Pregnant women with cervical cancer tend to be elder.It is usually diagnosed in the second and third trimester of pregnancy.The co-testing of cytology and HPV during pregnancy should be enhanced.Most patients have a strong desire to retain the fetus,so that individual treatment should be carried out according to the patient's desire and clinical characteristics.Pelvic MRI and neoadjuvant chemotherapy during pregnancy are safe and feasible.
作者
李思奇
王锐晨
赖晋
祝洪澜
赵超
李明珠
赵昀
李小平
梁旭东
王建六
魏丽惠
LI Siqi;WANG Ruichen;LAI Jin;ZHU Honglan;ZHAO Chao;LI Mingzhu;ZHAO yun;LI Xiaoping;LIANG Xudong;WANG Jianliu;WEI Lihui(Department of Obstetrics and Gynecology,Peking University People’s Hospital,Beijing 100044,China)
出处
《中国妇产科临床杂志》
CSCD
北大核心
2024年第5期396-399,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
基金
豪森临床医学学科发展项目(2020-J-05)。
关键词
宫颈癌
妊娠状态
个体化治疗
cervical cancer
gestation
individual management
