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目的总结妊娠合并宫颈癌临床特点、诊治及母婴预后。探讨保留胎儿治疗方法的临床价值。方法回顾性分析中山大学孙逸仙纪念医院2005年1月至2013年3月收治的7例妊娠合并宫颈癌患者临床资料及随访结果。结果 6例为单胎妊娠,1例为双胎妊娠。ⅠB1期1例,ⅠB2~ⅡA期5例,ⅡB期1例。鳞癌6例,腺癌1例。2例患者行胎儿在宫内的广泛全子宫切除,1例患者行放射治疗。4例患者要求保留胎儿,其中1例延期治疗8 d,3例采用顺铂联合紫杉醇新辅助化疗,均于孕33~33+6周行剖宫产加根治性手术。患者中位无瘤生存期为45个月。新生儿均未见明显畸形和生长发育异常。结论妊娠期应注意宫颈病变筛查。妊娠合并宫颈癌应结合临床分期、妊娠周数、生育意愿等制定个体化治疗方案。孕期顺铂联合紫杉醇新辅助化疗加剖宫产后根治性手术可能是妊娠合并宫颈浸润癌并要求保留胎儿患者的一种新的治疗选择,值得进一步临床研究。
Objective To summarize the clinical features, diagnosis, treatment and prognosis of pregnant women with cervical cancer. To discuss the clinical value of preserving fetal therapy. Methods The clinical data and follow-up results of 7 pregnant women with cervical cancer who were admitted to Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2005 to March 2013 were retrospectively analyzed. Results 6 cases of single pregnancy, 1 case of twin pregnancy. 1 case was stage IB, 5 cases were stage IB2-IIA, and 1 case was stage IIB. Six cases of squamous cell carcinoma and one case of adenocarcinoma. Two patients underwent extensive hysterectomy in the uterus, and one patient underwent radiotherapy. Four patients were required to retain the fetus, of which 1 case was postponed for 8 days and 3 cases were treated with neoadjuvant chemotherapy with cisplatin and paclitaxel. Cesarean plus radical surgery was performed at 33-33 + 6 weeks' gestation. Patients with median tumor-free survival of 45 months. Neonatal no obvious deformities and abnormal growth and development. Conclusions Pregnancy should pay attention to cervical lesions screening. Pregnancy with cervical cancer should be combined with clinical stage, number of weeks of pregnancy, fertility and other individualized treatment plan. Cisplatin in combination with paclitaxel Neoadjuvant chemotherapy plus radical cesarean postoperative radical surgery may be a new treatment option for pregnancy with cervical invasive carcinoma and fetus retention, deserving further clinical studies.