妊娠合并宫颈癌67例临床分析

摘要

目的:探讨妊娠合并宫颈癌患者的临床病理情况及治疗与妊娠结局.方法:回顾性分析2005年1月至2014年1月本院收治的67例妊娠合并宫颈癌患者临床病理资料.结果:67例患者中妊娠期诊断40例(59.7％),产后诊断27例(40.3％).患者平均年龄为34.3±5.3岁.临床表现以接触性出血为最常见34.3％.37例(55.2％)于孕早期或孕中期诊断.Ⅰ期宫颈癌占50.7％.主要病理类型为鳞癌共60例(89.6％).妊娠期诊断宫颈癌患者宫颈间质浸润深度＞ 1/2者显著高于产后诊断患者(P =0.022),其他临床病理资料两组差异无统计学意义(P＞0.05).37例妊娠期诊断患者选择立即终止妊娠并积极治疗宫颈癌,3例患者因有强烈生育愿望,孕期选择延迟治疗,待胎儿成熟终止妊娠后治疗宫颈癌,3例患者与3例新生儿均预后良好.67例患者均于我院手术治疗,13例死亡,5年累积生存率为76.4％.结论:妊娠合并宫颈癌临床分期相对较早,多数于孕早期及孕中期诊断,妊娠期与产后诊断患者的临床病理情况无明显差异.治疗方案应根据临床分期、肿瘤大小、淋巴结状态、肿瘤的病理类型、妊娠状态及患者及家庭对生育的要求等个体化制定.%Objective:To analyze the clinical and pathological characteristics,treatment strategies and prognosis of cervical cancer associated with pregnancy.Methods:Complete clinical data of 67 cases of cervical cancer associated with pregnancy was collected at the Second West China Hospital of Sichuan University between January 2005 and January 2014.Treatment and outcomes were analyzed comprehensively.Results:According to the inclusion criteria 67 patients were included,40 (59.7％) patients were diagnosed during pregnancy and 27 (40.3％) were diagnosed during postpartum.The mean age of those patients was 34.3 ±5.3 years old.The main clinical symptom was contact bleeding (34.4％).37(55.2％) patients were diagnosed in first or second trimester.50.7％ of patients were categorized as FIGO stage Ⅰ.The main histology subtype was squamous carcinoma (89.6％).The rates of patients with invasion depth in cervical stroma more than 1/2 were significantly higher in pregnancy period compared to that in postpartum period (P=0.022).There was no significant difference between cervical cancer diagnosed during pregnancy and postpartum in other clinical and pathological status.37 patients terminated pregnancies and received standard treatment promptly after diagnosis.3 patients had delayed treatment due to fertility reason.Outcomes of the three patients and neonates were good.All 67 patients received surgical treatment in our hospital eventually including 13 fatalities.Five year survival rate of cervical cancer associated with pregnancy was 76.4％.Conclusions:Cervical cancer associated with pregnancy was mostly early staged cancer and diagnosed at the first and second trimester.There was no difference of clinical and pathological status between patients diagnosed in pregnancy period or postpartum period.The management of cervical cancer during pregnancy is controversial and should discussed case-by-case according to FIGO stage,tumor size,lymph node status,histological subtype of tumor,term of pregnancy and patients wish.