广泛性子宫颈切除术后妊娠临床分析  

Clinical analysis of pregnancies after vaginal radical trachelectomy

作　　者：马良坤[1] 曹冬焱[1] 杨佳欣[1] 戚庆炜[1] 高劲松[1] 刘俊涛[1] 杨剑秋[1] 向阳[1] 沈铿[1] 郎景和[1] 

机构地区：[1]中国医学科学院北京协和医院妇产科,100730

出　　处：《中华妇产科杂志》2012年第12期883-887,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：国家科技支撑计划（2008BA157802）;北京市科学技术委员会首都临床特色研究（Z111107058811025）

摘　　要：目的探讨广泛性宫颈切除术（VRT）后妊娠的临床特点及处理。方法回顾性分析2003年12月至2012年5月在北京协和医院行VRT治疗的年轻早期宫颈癌患者42例的临床资料，其中10例患者成功妊娠。结果42例宫颈癌患者的平均年龄为（30．6±3．7）岁，分期分别为Ⅰa1期伴淋巴血管间隙浸润4例，Ⅰa2期4例，Ⅰb1期34例；平均随诊时间29．5个月。31例尝试妊娠的患者中10例患者成功妊娠14例次，总妊娠率为45％（14／31）。其中4例次为早孕期流产（2例胚胎停止发育而流产，2例意愿性人工流产），1例为异位妊娠手术；9例次妊娠至晚孕期（4例早产，早产率为4／9，其中〈孕32周早产者2例），均行子宫下段横切口剖宫产终止妊娠，平均分娩孕周为（35．7±2．9）周，新生儿平均出生体质量为（2594±689）g，无新生儿窒息，未发现新生儿畸形，无围产儿死亡。产后平均随诊22．9个月，宫颈细胞学检查结果正常，无肿瘤复发。结论VRT术后妊娠率为45％，且早产比例高。不建议VRT术中及孕期常规行宫颈环扎术，孕足月行子宫下段剖宫产术是适宜与安全的。Objective To explore the pregnancy outcome and obstetric management of pregnancy and delivery after vaginal radical traeheleetomy （VRT）. Methods Forty-two cases of VRT from December 2003 to May 2012 in Peking Union Medical College Hospital were analyzed retrospectively. Among them ten cases got pregnant successfully. Results The average age of patient at VRT surgery was （30. 6± 3.7 ） years old and average follow-up time was 29.5 months. There were 31 patients attempted conception. Ten of them got fourteen conceptions successfully. Overall conception rate was 45% （14/31）. There were four cases of first trimester abortion. Among them, two were miscarriage, two were elective abortion. There was one case of ectopic pregnancy operation and non of second trimester loss. Nine cases reached the third trimester. The total preterm delivery rate was 4/9. There were two cases delivered before 32 gestational weeks （2/9）. Cesarean section was performed through a transverse incision in all of nine cases. No uterine rupture and postpartum hemorrhage occurred. All newborns had good outcomes. The average follow-up time after postpartum was 22. 9 months. All cases were disease-free. Conclusions The conception rate of patients after VRT in our series is 45%. The preterm birth rate of pregnancy after VRT is higher. Routine cerclage of cervix during VRT procedure and pregnancy is not necessary. Cesarean section shortly after full term pregnancy through a transverse incision should be considered as a suitable and safe procedure.

关 键 词：宫颈肿瘤 妇科外科手术 妊娠率 妊娠结局 剖宫产术 

分 类 号：R713[医药卫生—妇产科学]