Reproductive outcomes of patients undergoing radical trachelectomy for early-stage cervical cancer
Reproductive outcomes of patients undergoing radical trachelectomy for early-stage cervical cancer
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DOI：
10.1016/j.ygyno.2012.03.014
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发表时间：
2012-06-01
影响因子：
4.7
通讯作者：
Sonoda, Y.
中科院分区：
文献类型：
--
作者：
Kim, C. H.;Abu-Rustum, N. R.;Sonoda, Y.
目标。目的：报道行保留生育能力的根治性气管切除术（RT）治疗早期宫颈癌患者的生殖结局。我们分析了2001年11月至2010年10月间本院第一批105例患者的数据，这些患者接受了保留生育能力的手术，包括根治性气管切除术、盆腔淋巴结切除术和结扎术。在105例接受放疗的患者中，77例（73%）不需要进行根治性子宫切除术或术后治疗。中位年龄32岁（范围25-38岁）。大多数患者（75%）为IB1期。66例（63%）未生育。术后6个月积极尝试受孕35例，成功受孕23例（66%），活产20例，择期终止妊娠3例，自然流产4例。4例患者各有2次妊娠：所有患者在32至36周之间进行了第二次妊娠。6例阴道壁发生环扎糜烂，经阴道拔除突出的缝合材料。其中一名患者经历了妊娠中期流产。大多数试图在根治性气管切除术后怀孕的妇女都是成功的，并且大多数怀孕导致足月分娩。辅助生殖在选定的妇女中发挥了重要作用。结扎可能有助于输卵管切除术后子宫将妊娠持续到妊娠晚期。输卵管切除术后的第二次妊娠似乎比第一次妊娠有更高的早产风险。(C) 2012爱思唯尔公司版权所有。
Objective. To report the reproductive outcomes of patients undergoing fertility-preserving radical trachelectomy (RT) for the treatment of early-stage cervical cancer.Methods. We analyzed data from our institution's first 105 patients who underwent attempted fertility-sparing surgery with radical trachelectomy, pelvic lymphadenectomy, and cerclage from November 2001 to October 2010.Results. Of the 105 patients who underwent attempted RT, 77 (73%) did not require a conversion to radical hysterectomy or postoperative treatment. The median age was 32 (range, 25-38 years). Most patients (75%) had stage IB1 disease. Sixty-six patients (63%) were nulliparous. Thirty-five women were actively attempting conception 6 months after surgery, and 23 (66%) women were successful in conceiving: there were 20 live births, 3 elective terminations, and 4 spontaneous miscarriages. Four patients had 2 pregnancies each: all delivered their second pregnancy between 32 and 36 weeks. Cerclage erosion through the vaginal wall occurred in 6 cases and was treated by transvaginal removal of protruding suture material. One of these patients experienced a second trimester miscarriage.Conclusions. The majority of women who attempted to conceive after radical trachelectomy were successful, and most of their pregnancies resulted in full-term births. Assisted reproduction played an important role in select women. Cerclage likely contributed to a post-trachelectomy uterine ability to carry a pregnancy to the third trimester. The second post-trachelectomy pregnancy appears to be at higher risk for preterm delivery than the first pregnancy. (C) 2012 Elsevier Inc. All rights reserved.