子宫颈癌保留生育功能治疗后的肿瘤学结局及生育结局分析  

Analysis of oncological and fertility outcomes after fertility-sparing therapy for cervical cancer

作　　者：杜欣颖 刘亚娜 付翰林 严淑萍[2] 毛萌[1] 王倩[1] 郭瑞霞[1] DU Xinying;LIU Ya'na;FU Hanlin;YAN Shuping;MAO Meng;WANG Qian;GUO Ruixia(Department of Gynecology,the First Affiliated Hospital of Zhengzhou University,Henan Key Medical Laboratory for the Prevention and Treatment of Gynecological Malignant Tumor,Henan Province Engineering Research Center of Gynecological Oncology Fertility Protection,Zhengzhou,450052,China;Department of Pathology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China)

机构地区：[1]郑州大学第一附属医院妇科,河南省妇科恶性瘤防治医学重点实验室,河南省妇科肿瘤生育力保护工程研究中心,郑州450052 [2]郑州大学第一附属医院病理科,郑州450052

出　　处：《中国妇产科临床杂志》2025年第2期108-112,共5页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：河南省中青年卫生健康科技创新领军人才培养项目(YXKC2020012)。

摘　　要：目的探讨子宫颈癌行保留生育功能手术(fertility-sparing surgery,FSS)治疗后的肿瘤学结局及生育结局。方法回顾性收集2013年1月至2023年8月在郑州大学第一附属医院接受FSS治疗的67例宫颈癌患者的临床资料。按照不同的手术方式分为非根治性FSS组(包括宫颈冷刀锥切术和单纯宫颈切除术)34例和根治性FSS组(广泛宫颈切除术)33例,分析患者的一般资料、病理特征、手术并发症、预后及生育结局。结果根治性FSS组术后并发症发生率均高于非根治性FSS组(30.3%vs.2.9%,P<0.05),包括近期并发症(18.2%vs.0.0%,P<0.05)及远期并发症(27.3%vs.2.9%,P<0.05)。两组总复发率为3.0%(2/67),两组3年无病生存率及总生存率均为100.0%(P>0.05)。非根治性FSS组的妊娠率(63.6%vs.36.8%)及活产率(62.5%vs.37.5%)均高于根治性FSS组(P>0.05)。亚组分析,根治性FSS组中环扎组的活产率高于未环扎组(100.0%vs.16.7%,P>0.05),而流产率低于未环扎组(0.0%vs.66.7%,P>0.05)。结论有生育需求的子宫颈癌患者选择FSS治疗是安全可行的,但术后仍需密切随访。Objective To investigate the oncological and fertility outcomes of cervical cancer after fertilitysparing surgery(FSS).Methods This study retrospectively collected the clinical data of 67 patients with cervical cancer who received FSS treatment in the First Affiliated Hospital of Zhengzhou University from January 2013 to August 2023.The patients were divided into 34 of non-radical FSS group[including cold knife conization(CKC)and simple trachelectomy(ST)]and 33 of radical FSS group(radical trachelectomy,RT)according to different surgical methods.The general data,pathological characteristics,surgical complications,prognosis and fertility outcomes of the patients were analyzed.Results The incidence of postoperative complications in the radical FSS group was higher than that in the non-radical FSS group(30.3%vs.2.9%,P<0.05),including short-term complications(18.2%vs.0.0%,P<0.05)and long-term complications(27.3%vs.2.9%,P<0.05).The overall recurrence rate was 3.0%(2/67)in the two groups,and the 3-year disease-free survival rate and overall survival rate of both groups were 100.0%(P>0.05).The pregnancy rate(63.6%vs.36.8%)and live-birth rate(62.5%vs.37.5%)in the non-radical FSS group were higher than those in the radical FSS group(P>0.05).In the subgroup analysis,the live-birth rate of the cerclage group was higher than in the noncerclage group(100.0%vs.16.7%,P>0.05),while the abortion rate was lower than that in the non-cerclage group(0.0%vs.66.7%,P>0.05).Conclusions FSS is a safe and feasible option for cervical cancer patients with fertility needs,but close follow-up is still required after surgery.

关 键 词：早期子宫颈癌 保留生育功能手术 预后结局 生育结局 

分 类 号：R737.33[医药卫生—肿瘤]