应用化疗-锥切术保留子宫颈癌患者生育功能的临床研究  

Fertility Preservation in Women with Cervical Cancer by Neoadjuvant Chemotherapy-Conization

作　　者：舒宽勇[1] 朱其舟[1] 王鹏[2] 熊树华[1] 肖仲清[1] 

机构地区：[1]江西省妇幼保健院肿瘤科 [2]南昌大学研究生院医学部,2014级南昌330006

出　　处：《南昌大学学报（医学版）》2017年第3期27-30,72,共5页Journal of Nanchang University：Medical Sciences

基　　金：江西省科技厅社会发展项目20111BBG70023-1

摘　　要：目的研究采用化疗-锥切术来治疗早期子宫颈癌患者能否成为一种可行的治疗方法。方法选取2011年1月至2016年1月在江西省妇幼保健院肿瘤科住院的早期子宫颈癌患者15例,进行新辅助化疗后评估治疗效果,随后进行腹腔镜下盆腔淋巴结切除,并根据术中冰冻淋巴结病理结果决定行宫颈锥切术或宫颈癌根治手术,同时宫颈锥切标本送术中冰冻切片并决定是否需要补充治疗。结果 15例患者中,有5例患者在化疗过程中要求行宫颈癌根治手术,未能完成预定治疗计划;另10例患者在完成化疗后行腹腔镜下盆腔淋巴结切除术,术中冰冻切片提示阴性后顺利行宫颈锥切术。在10例完成化疗-锥切治疗的患者中,1例术后1年复查宫颈活检提示宫颈上皮内瘤变3级(CIN3),2例患者表现为CIN1(1年)和CIN2(2年)。有2例患者在随访期间成功妊娠,1例患者妊娠至38周行剖宫产1子;另1例患者妊娠至12周自然流产。结论化疗-锥切术是值得进一步研究的保留早期子宫颈癌患者生育功能手术的治疗方法。Objective To study the possibility that neoadjuvant chemotherapy-conization becomes a viable way for the treatment of early stage cervical cancer.Methods Fifteen patients hospitalized in the Department of Oncology of Jiangxi Maternal and Child Healthcare Hospital from January 2011 to January 2016 for early stage cervical cancer were selected in this study.After neoadjuvant chemotherapy,the therapeutic effect was assessed and laparoscopic pelvic lymph node excision was carried out in all patients.In addition,intraoperative pathologic examination of lymph node was performed to select cervical conization or radical surgery,and intraoperative pathologic examination of cervical conization specimens was performed to decide whether supplementary therapy was needed.Results Among the 15 patients,5failed to complete predetermined treatment plan due to asking for radical surgery during chemotherapy.The other 10 patients underwent laparoscopic pelvic lymph node excision after chemotherapy and received cervical conization after negative frozen section diagnosis.Among the 10 patients,cervical biopsy showed that 1patient had cervical intraepithelial neoplasia(CIN)3(after 1 year of follow-up)and 2 patients had CIN1(after 1year of follow-up)and CIN2(after 2years of follow-up).Among the 2 patients who got pregnant during follow-up,1 was delivered by cesarean section at 38 weeks of gestation,and 1 had spontaneous abortion at 12 weeks of gestation.Conclusion Neoadjuvant chemotherapy-conization deserves further study for fertility preservation in patients with early stage cervical cancer.

关 键 词：子宫颈癌 化疗-锥切术 生育功能 保留 

分 类 号：R737.33[医药卫生—肿瘤]