孕34周前确诊妊娠合并子宫颈癌患者继续妊娠治疗方案及母儿预后分析  

Management strategy and maternal and fetal prognosis of patients diagnosed with cervical cancer and continuing pregnancy before 34 weeks of gestation

作　　者：尹惠芬 朱静 朱好 刘海燕 顾蔚蓉 胡蓉 YIN Hui-fen;ZHU Jing;ZHU Hao;LIU Hai-yan;GU Wei-rong;HU Rong(Department of Obstetrics,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China;Department of Gynecology,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院产科,上海200011 [2]复旦大学附属妇产科医院妇科,上海200011

出　　处：《复旦学报（医学版）》2024年第5期749-756,共8页Fudan University Journal of Medical Sciences

摘　　要：目的总结孕34周前确诊并继续妊娠的子宫颈癌患者的治疗方案、治疗时机以及终止妊娠时机,为改善母儿预后提供临床经验与参考。方法回顾性收集复旦大学附属妇产科医院2013年1月至2024年2月期间收治入院的妊娠合并子宫颈癌患者的临床资料,对孕34周前确诊且选择继续妊娠患者的治疗时机、治疗方案进行回顾,并对母儿结局进行随访分析。结果共有15例患者纳入本研究,中位年龄为34岁。9例(9/15)患者因异常阴道流血就诊,14例(14/15)患者诊断时处于孕中晚期,诊断时12例(12/15)患者肿瘤最大直径超过2 cm。13例患者(13/15)感染HPV16或18型,主要病理类型为鳞癌(9/15)。治疗方面,1例Ⅰa1期患者孕期密切随访,孕35周因“疤痕子宫、胎膜早破”行剖宫产术+全子宫切除术;其余14例Ⅰb期患者,孕中期行腹腔镜下盆腔淋巴结清扫术或行影像学检查除外淋巴结转移后,给予相应疗程的新辅助化疗延长孕周,继续妊娠至34周左右终止妊娠,然后规范化治疗肿瘤。分娩术后1例病理升级至Ⅱa1期。截至随访时间,15例患者中13名患者无瘤存活。新生儿平均分娩孕周为(35.0±1.5)周,平均出生体重为(2345.33±431.44)g。随访出生后第一天新生儿血常规发现:低白细胞8例(8/15),贫血1例(1/15)。经短期住院支持治疗后,最终所有新生儿结局良好。结论对于孕34周前确诊妊娠合并子宫颈癌Ⅰb期的患者,行新辅助化疗延长至孕34周后终止妊娠,再行肿瘤规范化治疗是相对安全的,母儿结局良好。Objective To summarize the treatment of cervical cancer patients diagnosed before 34 weeks of gestation who chose to continue pregnancy,and to provide clinical experience for improving maternal and fetal outcomes.Methods Clinical data of pregnant women with cervical cancer admitted to the Obstetrics and Gynecology Hospital,Fudan University from Jan 2013 to Feb 2024 were collected and analyzed.Treatment of patients diagnosed before 34 weeks of gestation and chose to continue pregnancy was summarized.Outcomes of patients and newborn were followed up.Results A total of 15 patients were enrolled with a median age of 34 years old.Nine cases(9/15)represented clinical symptom of abnormal vaginal bleeding,14 cases(14/15)of patients were diagnosed in the middle or late stages of pregnancy,12 cases(12/15)diagnosed with tumor size of more than 2 cm,13 patients(13/15)infected HPV type 16 or 18.The main pathological type was squamous cell carcinoma(9/15).Regarding therapy,one patient with stageⅠa1 was under observation and underwent a caesarean section and total hysterectomy at 35 weeks of gestation due to premature rupture of membrane and a scarred uterus.For the other patients with 14 stageⅠb,lymph node metastasis was excluded by pelvic lymphadenectomy or MRI,and then neoadjuvant chemotherapy was administered.Termination of pregnancy and standardized treatment for cervical cancer were provided after 34 weeks of gestation.One patient’s pathology was upgraded to stageⅡa1 after surgery.Up to follow-up,13 out of 15 patients had survived without tumors.The average gestational age of newborns was(35.0±1.5)weeks,and the average birth weight was(2345.33±431.44)g.Blood tests conducted one day after delivery of the newborns revealed that:8 newborns(8/15)had hypoleukocyte and one newborn(1/15)had anemia.After short-term hospitalization and supportive treatment,all newborns’progress was favorable.Conclusion For pregnant patients with stageⅠb cervical cancer diagnosed before 34 weeks of gestation,postponing termination to

关 键 词：妊娠 子宫颈癌 母儿妊娠结局 

分 类 号：R714[医药卫生—妇产科学] R711.74[医药卫生—临床医学]