妊娠合并宫颈癌的临床分析

目的：分析妊娠合并宫颈癌的临床表现、诊断、治疗及妊娠结局。方法：收集2018年4月至2020年6月温州医科大学附属第一医院收治的5例妊娠合并宫颈癌患者的临床病理资料，进行回顾性分析。结果：患者年龄30～35岁，中位年龄31岁。其中妊娠期诊断4例（孕早期1例，孕中期2例，孕晚期1例），产后1例。临床表现以不规则阴道流血最为常见。根据FIGO 2018分期，IA2期1例，IB2期1例，IB3期3例。病理类型：鳞癌4 例，腺癌1例。1例孕早期患者直接行宫颈癌根治术，另外3例剖宫产同时行宫颈癌根治术，其中2例行新辅助化疗延长孕周，分娩时的孕周为（33.0±1.5）周；产后1例行保留生育功能的根治性宫颈切除术。术后补充放化疗3例，单纯化疗2 例。4 例新生儿均健康存活。结论：妊娠期出现阴道不规则流血应及时妇科检查警惕宫颈癌。妊娠合并宫颈癌应结合FIGO分期、孕周及患者生育意愿，联合放化疗科、新生儿科等进行多学科讨论，制定个体化治疗方案。适当应用新辅助化疗延长孕周、控制肿瘤进展，提高胎儿存活率。

A clinical analysis of cervical cancer associated with pregnancy

Objective: To analyze the clinical manifestations, diagnosis, treatment strategies and prognosis of cervical cancer associated with pregnancy. Methods: The clinicopathological data of patients with cervical cancer associated with pregnancy, who were admitted to the First Affiliated Hospital of Wenzhou Medical University from April 2018 to June 2020, were collected and retrospectively analyzed. Results: The patients ranged in age from 30 to 35 averaged 31 years old. Among them, 4 cases were diagnosed during pregnancy, 1 case in the early pregnancy, 2 cases in the second trimester, 1 case in the third trimester and 1 case in postpartum.The most common clinical manifestation was irregular vaginal bleeding. According to FIGO 2018 staging,there was 1 case of stage IA2, 1 case of stage IB2, and 3 cases of stage IB3. Pathological type: 4 squamous cell carcinoma cases and one adenocarcinoma case. One patient received radical hysterectomy in early pregnancy,and the other 3 patients received radical hysterectomy in cesarean section at the same time. Among them, 2 patients received neoadjuvant chemotherapy (NACT) to extend the gestational age, and the gestational age at delivery was (33.0±1.5) weeks. One patient was postpartum and underwent radical trachelectomy. Three cases received chemoradiotherapy and 2 cases did postoperative chemotherapy. All 4 newborns were healthy and alive.Conclusion: The vaginal irregular bleeding during pregnancy needs timely gynecological examination to exclude cervical cancer. Cervical cancer associated with pregnancy should be combined with FIGO stage, gestational age and the patient’s fertility desire, combined with radiotherapy and chemotherapy department as well as neonatal department for multidisciplinary discussions in order to develop individualized treatment plan. Appropriate application of neoadjuvant chemotherapy is recommended to prolong gestational age, control tumor progression and improve fetal survival rate.