肿瘤预防与治疗2025，Vol.38Issue(4)：296-305,10.DOI:10.3969/j.issn.1674-0904.2025.04.007
早期宫颈癌患者根治性宫颈切除术的预后及生育情况分析
Prognosis and Fertility Outcomes in Patients with Early-Stage Cervical Cancer after Radical Trachelectomy
摘要
Abstract
Objective:To investigate the oncological outcomes and reproductive function after radical trachelectomy(RT)in patients with early-stage cervical cancer who desire fertility preservation.Methods:We collected and analyzed the clinical data of 30 patients with early-stage cervical cancer who underwent RT in the Department of Gynecology at Guangxi Medical University Cancer Hospital between 2002 and 2023.Results:All 30 patients desiring fertility preservation underwent RT,with a mean age of 32.43±5.95 years.According to FIGO 2009 staging(for patients before 2018)and FIGO 2018 staging(for patients from 2018 onward),the cohort included:9 cases of IA1 with lymphovascular space invasion,4 IA2,12 IB1,4 IB2,and 1 IB3.The pathological types included 22 cases of squamous cell carcinoma,6 of adenocarcinoma,and 1 case each of adenosquamous carcinoma and clear cell carcinoma.Eight patients with cervical cancer(tumor size 2～4 cm)under-went 1～2 cycles of paclitaxel plus platinum-based neoadjuvant chemotherapy.Among the 30 patients treated with RT,24 underwent vaginal radical trachelectomy,1 abdominal radical trachelectomy,and 5 laparoscopic radical trachelectomy.Radi-cal hysterectomy was performed in one patient due to positive surgical margins identified on intraoperative frozen section.One patient required right inguinal repair for an intraoperative right deep circumflex iliac vein tear and developed postoperative right leg deep vein thrombosis,while other cases had no complications.Postoperatively,12 patients received adjuvant chemo-therapy,including 6 cases with tumor diameter>2 cm and/or adenocarcinoma pathology,4 cases with lymphovascular space invasion,1 case with superficial myometrial invasion,1 case with stage ⅠB3 clear cell carcinoma.Of these,11 patients re-ceived 1～4 cycles of adjuvant paclitaxel/platinum-based chemotherapy,1 patient received 1 cycle of fluorouracil+cisplatin regimen.The mean follow-up duration was 49.2±33.66 months.Postoperative recurrence occurred in 2 cases(6.67％,2/30),with 1 mortality case(3.33％,1/30).Among 15 patients with preserved fertility intention postoperatively,5 achieved pregnancy(33.3％,5/15),including 2 natural conceptions(40.0％,2/5)and 3 assisted reproductive technology-mediated conceptions.Four pregnancies resulted in term deliveries(all via cesarean section),while 1 case ended in spontaneous a-bortion(20.0％,1/5).Multivariate analysis demonstrated that pathological type was significantly associated with prognosis(P<0.05),whereas neither clinical stage nor surgical approach showed statistically significant effects(both P>0.05).Fisher's exact test indicated no statistically significant associations between pregnancy outcomes and clinical stage,patholog-ical type,surgical approach,or age(all P>0.05).Conclusion:RT demonstrates no significant impact on prognosis in ear-ly-stage cervical cancer while effectively preserving reproductive function,suggesting its clinical applicability.关键词
根治性宫颈切除/早期宫颈癌/预后/妊娠结局Key words
Radical trachelectomy/Early cervical cancer/Prognosis/Pregnancy outcome分类
临床医学引用本文复制引用
李玲,蒋玲玲,李状,杜佳园,苏金秋,余耀杰,王鹤..早期宫颈癌患者根治性宫颈切除术的预后及生育情况分析[J].肿瘤预防与治疗,2025,38(4):296-305,10.基金项目
国家自然科学基金(编号:82160443) （编号:82160443）
广西自然科学基金(编号:2020GXNSFAA159023) This study was supported by National Natural Science Foundation of China(No.82160443)and Natural Science Foundation of Guangxi Province(No.2020GXNSFAA159023). （编号:2020GXNSFAA159023）
