妊娠合并宫颈疾病诊治进展

妊娠期宫颈可发生炎性疾病,人乳头瘤病毒(HPV)感染,宫颈上皮内瘤样病变(CIN)甚至宫颈浸润癌。近年来,对妊娠期宫颈疾病的关注度逐渐上升。妊娠合并宫颈疾病可通过细胞学检查、HPV-DNA检测、P16/Ki67双联染色、阴道镜、活检和宫颈锥切等进行诊断。治疗方面妊娠合并HPV感染没有特别治疗;CIN患者排除宫颈浸润癌后可行细胞学及阴道镜随访至分娩;妊娠合并宫颈癌的处理较为复杂,需要考虑到肿瘤治疗与胎儿安全之间的平衡,治疗需综合考虑肿瘤大小、淋巴结转移情况及患者继续妊娠的意愿。分娩时机及分娩方式方面,合并宫颈感染性疾病及CIN的妊娠患者均按照产科处理;Ⅰa1期、间质浸润深度3 mm并且切缘阴性宫颈癌患者可妊娠至足月阴道试产,对于更高期别患者建议胎儿成熟后剖宫产终止妊娠。

Advances in the Diagnosis and Treatment of Pregnancy Complicated with Cervical Disease

During pregnancy, patients perhaps suffer from inflammatory diseases, HPV infection, cervical intraepithelial neoplasia and cervical cancer. In recent years, pregnancy complicated with cervical disease is getting more attention. Cervical disease in pregnancy can be diagnosed by cervical cytology, HPV-DNA, P16/Ki67 dual-stained cytology, colposcopy and biopsy, cervical conization etc. For management of cervical disease in pregnancy, there is no special treatment for HPV infection. Once presence of invasive cancer is ruled out definitive treatment can be deferred to the postpartum period for CIN lesions. The treatment of cervical cancer in pregnancy is complex. We have to take into consideration the optimal oncologic therapy as well as the preservation of the health of the fetus. Treatment options include conservative and surgical approaches based on tumor size, lymph node involvement and the patient′s wish to continue the pregnancy. About termination time and delivery mode, for patients with inflammatory diseases, HPV infection, CIN were treated according to the rule obstetrical. Cervical cancer in stage Ⅰa1, stromal invasion <3 mm and negative margins, a term delivery (>37 weeks gestation) and natural vaginal birth are preferred. In higher stage tumors, we propose delay of pregnancy termination until fetal maturity, and cesarean delivery is necessary.