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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。
Objective To investigate the clinical value of tumor and pregnancy outcome after preserving reproductive function of cervical cancer. Methods From January 2008 to May 2012, 55 cases of cervical cancer patients who retained reproductive function in nine research centers in Beijing were selected as the research object. The clinical data and follow-up results were collected and the data were statistically analyzed. Results 55 cases of cervical squamous cell carcinoma in 52 cases, 3 cases of cervical adenocarcinoma; FIGO (2009) stage ⅠA1 17 cases, Ⅰ A2 7 cases, ⅠB1 31 cases; 48 cases of extensive cervical resection + retroperitoneal lymph node dissection , 7 cases of extensive cervical resection plus retroperitoneal lymph node dissection; 11 cases of neoadjuvant chemotherapy preoperative 1-2 courses of treatment, 9 cases of postoperative chemotherapy for 1 to 6 courses. 53 cases (96.4%) were followed up after a median of 19.2 months, 49 cases (92.5%) were satisfied with the current quality of life. Tumor outcomes and pregnancy outcomes were as follows: ① One (1.9%) patients had tumor recurrence after fertility maintenance; ② Nine of 26 patients (9/26, 34.6%) had pregnancy after pregnancy with 11 pregnancies; Full-term delivery 6 times (6/11,54.5%), premature birth 2 times (2 / 11,18.2%), spontaneous abortion (10 weeks), induced abortion (8 weeks) and medical abortion 1/11, 9.1%). Conclusions Extensive / subtotal cervical resection, as a treatment for preserving reproductive function in young patients with early stage cervical cancer, is safe, effective and has good pregnancy outcomes.