早期宫颈癌锥切治疗后肿瘤及妊娠结局的观察

目的探讨宫颈冷刀锥切术在早期宫颈癌保留生育功能治疗后的肿瘤结局和妊娠情况以及其对临床的指导价值。方法选取6个研究中心的52例保留生育功能治疗的宫颈癌患者为研究对象,收集临床资料及随访结果,对数据进行统计分析。结果①50例成功锥切的患者中,有2例ⅠA1期患者术后复发,总复发率4%（2/50）,平均复发时间20.5个月。这2例均为中分化癌并多点浸润,且有盆腔淋巴结转移;②50例患者中15例有生育要求并尝试妊娠,有7例（46%）共9人次妊娠;其中足月分娩3人次（20%）,顺产1人次、剖宫产2人次。药物流产（6周）1人次;自然流产（24周）1人次,并诊断为宫颈机能不全;早孕胎停育（8周）3人次;宫外孕1人次,平均妊娠时间术后10个月。结论宫颈冷刀锥切术用于年轻ⅠA1期宫颈癌患者安全有效,妊娠结局良好,但应局限于高分化癌患者。

Oncological safety and pregnancy after Cold-knife Conization in early-stage cervical cancer

Objective To explore the oncological safety and pregnancy in early-stage cervical cancer patients after undergoing the Cold-knife Conization （CKC）. Methods A total of 50 cervical cancer patients from six research centers who underwent fertility-sparing treatments （CKC） were recruited in this study. Their clinical and follow-up records were analyzed.Results ① Tumor recurrence developed in 2 of the 50patients （4%） with the average recurrence time 20.5 months. These two cases were both stage Ia1 with multi-point infiltration and the pathological types were median-differentiation. Despite the postoperative pathologic indicating negative margins, both patients were confirmed of positive pelvic lymph node metastasis in the followed surgeries. ② 15 patients had fertility requirement and nine pregnancies occurred in 7 women （46%）. Among which, 3 were full-term labors （20%） including 1 natural delivery and 2 cesarean section. One spontaneous abortion （24 weeks） due to cervical insufficiency occurred. Others included one drug abortion （6 weeks）, 3 missed abortion （6 weeks） and one ectopic preganancy. The average time of pregnancy after surgery was 10 moths. Conclusions Cold-knife Conization （CKC） is a safe and effective fertility-sparing treatment for the young cervical cancer patients with early-stages, and the outcomes of the fertility and pregnancy is good. However,it must be limited to the patients with high-differentiation tumors.