妊娠期宫颈癌21例临床分析  

Clinical analysis of 21 cases of cervical cancer during pregnancy

作　　者：刘静[1] 杨丽珺 李玉宏[2] 王玉东[2] 王建东[1] Liu Jing;Yang Lijun;Li Yuhong;Wang Yudong;Wang Jiandong(Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026,China;The International Peace Maternity and Child Health Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 201908,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院,北京100026 [2]上海交通大学医学院附属国际和平妇幼保健院,上海201908

出　　处：《中国医刊》2024年第3期314-318,共5页Chinese Journal of Medicine

基　　金：北京宫颈癌临床数据与样本资源库发展与应用研究(D131100005313009)。

摘　　要：目的通过分析妊娠期宫颈癌的临床特点及预后,为妊娠期宫颈癌的筛查、管理及治疗提供依据。方法回顾性分析2015年1月至2023年1月就诊于首都医科大学附属北京妇产医院及上海交通大学医学院附属国际和平妇幼保健院的21例妊娠期宫颈癌患者的临床资料,总结其临床表现、组织病理学检查结果、治疗方法及妊娠结局。结果妊娠期宫颈癌患者共21例,有7例患者在妊娠期反复阴道出血,就诊后发现宫颈肿物,或为菜花状,或为质硬肿物,表面毛糙,经阴道镜活检病理检查提示宫颈癌,其余14例均无特异性临床表现。妊娠结局包括流产7例,早产9例,足月产5例。组织病理学检查结果提示宫颈腺癌2例,宫颈腺鳞癌4例,子宫内膜样腺癌1例,宫颈鳞癌14例。8例宫颈癌Ⅰa1期患者中,1例产后手术治疗,1例孕16周手术治疗后妊娠至足月,5例流产后手术治疗,1例剖宫产后手术治疗。1例宫颈癌Ⅰa2期患者产后手术治疗,1例宫颈癌Ⅰb1期患者孕9周手术治疗,1例宫颈癌Ⅰb2期患者孕8周手术治疗,1例宫颈癌Ⅰb3期患者孕34周剖宫产后手术治疗,1例宫颈癌Ⅱa1期患者产后手术联合放化疗治疗。3例宫颈癌Ⅱa2期患者中,1例孕期TC方案(紫杉醇+卡铂)化疗5次,剖宫产后手术治疗联合术后补充放疗;1例延迟孕周期待至剖宫产,剖宫产后手术治疗联合术后补充放疗;1例孕20周开始给予TC方案化疗两次,剖宫产后手术治疗。5例宫颈癌Ⅱb期患者中,均剖宫产后予以放化疗和/或手术治疗。随访至2023年1月,除流产3例及失访2例外,其余母婴状况均良好。结论在妊娠期应及时完善宫颈癌筛查,早期筛查、早期诊断及个体化治疗可延长妊娠期宫颈癌患者的孕周,减少母婴并发症,提升母婴存活质量。Objective To analyze the clinical characteristics and prognosis of cervical cancer during pregnancy,and explore the screening,management,and treatment of pregnancy.Method The clinical data of 21 patients with cervical cancer during pregnancy who were admitted to Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University and International Peace Maternal and Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2023 were retrospectively analyzed.The clinical manifestations,histopathological examination results,treatment methods and pregnancy outcomes were summarized.Result A total of 21 patients with cervical cancer during pregnancy.7 patients had recurrent vaginal bleeding during pregnancy,and cervical mass was found after treatment,or cauliflower-shaped,or hard mass,with rough surface.The pathological examination of colposcopy suggested cervical cancer,and the other 14 patients had no specific clinical manifestations.Among them,7 cases were miscarriage,9 cases were premature delivery,and 5 cases were full-term delivery.The histopathological examination results suggested cervical adenocarcinoma in 2 cases,cervical adenosquamous carcinoma in 4 cases,endometrioid adenocarcinoma in 1 case,and cervical squamous carcinoma in 14 cases.Among the 8 patients with cervical cancer stageⅠa1,1 case was treated postpartum,1 case was treated postpartum after 16 weeks of pregnancy,5 cases were treated after abortion,and 1 case was treated after cesarean section.Postpartum surgical treatment for 1 case with stageⅠa2 cervical cancer.1 case of cervical cancer stageⅠb1 patient underwent surgical treatment at 9 weeks of pregnancy.1 case of cervical cancer stageⅠb2 patient underwent surgical treatment at 8 weeks of pregnancy.1 case of cervical cancer stageⅠb3 patient underwent surgical treatment after cesarean section at 34 weeks of pregnancy.Postpartum surgery combined with radiotherapy and chemotherapy for 1 case with stageⅡa1 cervical

关 键 词：宫颈癌 妊娠期 诊疗 妊娠结局 

分 类 号：R737.3[医药卫生—肿瘤]