早期宫颈癌保留生育功能治疗后肿瘤和妊娠结局的多中心研究

目的探讨宫颈癌保留生育功能治疗后肿瘤和妊娠结局对临床的指导价值。方法选取北京市9个研究中心2008年1月至2012年5月55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,对数据进行统计学分析。结果 55例中子宫颈鳞癌52例,子宫颈腺癌3例;FIGO（2009）分期ⅠA1期17例,ⅠA2期7例,ⅠB1期31例;48例行广泛宫颈切除＋腹膜后淋巴结切除术,7例行次广泛宫颈切除＋腹膜后淋巴结切除术;11例术前行新辅助化疗1～2疗程,9例术后进行1～6个疗程的化疗。术后完成随访53例（96.4%）,中位随访时间19.2个月,49例（92.5%）对目前生活质量满意。肿瘤结局和妊娠结局如下：①保留生育功能治疗后肿瘤复发1例（1.9%）;②治疗后有妊娠计划的26例患者中,9例（9/26,34.6%）共有11次妊娠;其中足月分娩6次（6/11,54.5%）,早产2次（2/11,18.2%）,自然流产（10周）、人工流产（8周）及药物流产（6周）各1次（1/11,9.1%）。结论广泛/次广泛宫颈切除术作为年轻早期宫颈癌患者保留生育功能的治疗方法,安全有效,妊娠结局良好。

A multi-center study on the outcomes of the oncology,fertility and pregnancy in patients after undergoing the fertility-sparing treatments with early-stage cervical cancer

Objective To explore the outcomes of the oncology, the fertility and pregnancy on patients with cervical cancer after undergoing fertility-sparing treatments, and to investigate its value on clinical treatment. Methods A total of 55 patients with cervical cancer who had undergone the fertility-sparing treatments from nine research centers in Beijing since Jan 2008 to May 2012 were recruited in this study, their clinical and follow-up records were analyzed. Results Among the 55 patients, there were 52 cases of squamous cell carcinoma, 3 cases of adenocarcinoma; 17 with in stage ⅠA1, 7 cases with stage ⅠA2 and 31 cases with stage ⅠB1 （FIGO,2009）. 48 patients underwent radical trachelectomy （RT） ＋retroperitoneal lymphadenectomy, 7 patients underwent subradical trachelectomy＋retroperitoneal lymphadenectomy, 11 cases received neoadjuvant chemotherapy of 1~2 courses, 9 cases reveived chemotherapy of 1~6 courses after surgery. 53 patients under follow-up（96.4%） with the median follow-up time 19.2 months. 49 patients（92.5%）were satisfied with the quality of life currently. The outcomes of the oncology and pregnancy were as follows： ① One patient relapsed （1.9%） after the fertility-sparing treatments. ② In 26 patients who had fertility requirement after treatments, eleven pregnancies occurred in 9 women （9/26,34.6%）. Among them, full-term labor was six times （6/11,54.5%）, preterm labor was two times（2/11,18.2%）, spontaneous abortion （10 weeks）, induced abortion （8 weeks）, and drug abortion （6 weeks） was once respectively （1/11,9.1%）. Conclusions RT or subradical trachelectomy is a safe and effective fertility-sparing treatment for young women with early-stage cervical cancer, The outcomes of the fertility and pregnancy is satisfied.