妊娠期子宫颈微小浸润鳞癌延迟治疗的孕期观察和母儿结局  

Cervical microinvasive squamous carcinoma during pregnancy： observation and outcome of pregnancy with planned delayed treatment

作　　者：王彤[1] 吴玉梅[1] 宋芳[1] 朱力[2] 郝霞[1] 孔为民[1] 段微[1] 范玲[3] 张为远[3] 

机构地区：[1]首都医科大学附属北京妇产医院妇瘤科,100006 [2]首都医科大学附属北京妇产医院病理科,100006 [3]首都医科大学附属北京妇产医院产科,100006

出　　处：《中华妇产科杂志》2012年第12期888-892,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的评价妊娠期宫颈微小浸润鳞癌延迟至胎儿成熟在产后治疗的可行性和母儿结局。方法采用前瞻性研究方法选择2007年8月1日至2010年5月31日在北京妇产医院产科门诊检查且孕前1年内未进行过宫颈液基薄层细胞学检查（TCT）的孕妇进行TCT筛查，对TCT结果异常者，进行阴道镜检查和阴道镜指导下宫颈活检。病理诊断宫颈微小浸润鳞癌（浸润深度43mm）的孕妇在知情同意后选择继续妊娠，每8～12周复查阴道镜，可疑病变进展可再次阴道镜指导下宫颈活检；适时指导分娩，产后6～12周进行第1次复查阴道镜＋宫颈活检，之后行宫颈冷刀锥切术（CKC）。记录母儿结局及随访情况。结果TCT筛查孕妇共27230例，病理检查报告宫颈微小浸润鳞癌17例，检出率为0．062％（17／27230）。15例孕妇在知情同意后选择了继续妊娠，其初次诊断孕周（19．3±5．9）周，孕期阴道镜检查2～4次，1例孕妇从孕22周随诊至孕34周经阴道镜检查及宫颈活检诊断病变进展，提前行剖宫产术终止妊娠，孕期进展率为1／15。分娩孕周34～40周，平均（37．1±1．8）周，平均延迟分娩时间（18．4±5．2）周。分娩方式全部为剖宫产术。新生儿全部健康存活。产后行CKC最终病理确诊为宫颈鳞癌Ⅰa2期1例，宫颈鳞癌Ⅰa1期11例，宫颈上皮内瘤变（CIN）Ⅲ3例。全部15例患者术后随访时间22—48个月，中位随访时间38个月，宫颈细胞学检查及妇科检查未发现异常。结论妊娠期对1年内未进行宫颈细胞学检查的孕妇进行TCT检查是必要的；宫颈微小浸润鳞癌在阴道镜等手段监测下严密随诊推迟至胎儿成熟在产后再进行治疗是可行的。Objective To evaluate the maternal and fetal outcomes of planned delay in treatment for cervical microinvasive squamous cancer during pregnancy. Methods A prospective study of pregnant women was done from August 1, 2007 to May 31, 2010. Pregnant women who had not been carried out cervical cytological screening within one year were got thin-prep cytology test （TCT） screening at their initial prenatal visit. Patients with abnormal cytological results were performed colposcopic examination and directed biopsy. Women with cervical microinvasive cancer were followed up every 8 to 12 weeks. If lesion progression were suspected, compared with previous image, repeated biopsy directed by colposcopy should be performed. Once worsening invasive cancer was confirmed, the pregnancy should be terminated timely. All patients should be reevaluated 6 to 12 weeks postpartum with repeated colposcopic examination and biopsy. All mothers were performed cold knife conization （CKC） at 6 to 12 weeks postpartum. Results We totally diagnosed 17 cases cervical microinvasive squamous carcinoma during pregnancy. The positive rate is 6. 2/10 000 （17/27 230）. After informed consent, 15 pregnant women decided to delay treatment until fetal maturation. The mean gestational age of initial diagnosis was （ 19. 3 ± 5.9） weeks. The women were followed up 2 to 4 times during pregnancy. Only 1 patient was verified lesion progression by directed biopsy at34 weeks and delivered by cesarean section. The progression rate during pregnancy was 1/15. The mean delivered time was （ 37. 1 ± 1.8 ） weeks （ ranged from 34 to 40 weeks ）. The mean diagnosis-to-delivery interval was （18.4 ±5.2） weeks. All patients were delivered by cesarean section and all newborns had good outcomes. Finally we confirmed 1 case with cervical cancer stage Ⅰa2, 11 cases with stageⅠ al, 3 cases with cervical intraepithelial neoplasia （CIN） Ⅲ by pathological diagnosis after CKC during 6 to 12 weeks postpartum. All cases were disease free after foll

关 键 词：妊娠并发症 肿瘤 宫颈肿瘤 癌 鳞状细胞 阴道镜检查 治疗 时间因素 妊娠结局 

分 类 号：R737.33[医药卫生—肿瘤]