妊娠合并宫颈癌患者继续妊娠的治疗方法研究进展

妊娠合并宫颈癌虽然不常见,但却是临床上棘手的问题,随着妊娠年龄的推迟,未来妊娠合并宫颈癌的发病率会更高。治疗过程中,不仅要考虑患者的健康,同时要兼顾胎儿,若选择继续妊娠要尽量减小对胎儿的不良影响,同时采取措施延缓肿瘤进展,达到与非妊娠宫颈癌患者相同的治疗结局。目前妊娠合并早期宫颈癌继续妊娠可选择的治疗方案有期待治疗、手术治疗和化学药物治疗,手术方式包括广泛性宫颈切除术、单纯宫颈切除术和宫颈锥切术,化疗药物则以铂类为基础,单药化疗或联合化疗。通常ⅠA1期妊娠合并宫颈癌患者可进行期待治疗,ⅠA2~ⅠB1期妊娠合并宫颈癌患者可选择手术治疗,ⅠB1期以上妊娠合并宫颈癌患者推荐新辅助化疗,发现淋巴结转移的患者理论上应停止妊娠。现对妊娠合并宫颈癌继续妊娠的治疗方法的最新研究进展进行总结。

The Progress on Pregnancy-Preserving Management of Cervical Cancer during Pregnancy

As the age of pregnancy grows, the rate of cervical cancer during pregnancy is increasing and the management of cervical cancer during pregnancy is also becoming more difficult in clinic. During treatment, safety of both pregnant women and offspring should be taken into account. Management of patients wishing to preserve of her pregnancy aim at fewer adverse effects on fetuses, less tumor progress and similar outcomes with non-pregnancy women with cervical cancer. Current options to treat pregnant patients with cervical cancer desired to preserve pregnancy contains expectant treatment, surgery and chemotherapy. Radical trachelectomy, simple trachelectomy and conization are common surgical methods and most common chemotherapy is based on platinum，with or without other agents. Commonly, patients with stage ⅠA1 cervical cancer are eligible for expectant treatment. Surgical treatment is option for patients with stage ⅠA2-ⅠB1 cervical cancer and neoadjuvant chemotherapy is used in patients with stage ⅠB1 or greater cervical cancer. Patients with lymph nodes metastasis should terminate pregnancy. We will make conclusions on the latest progression of pregnancy-preserving managements.