Rodriguez M, Guimares O, Rose P G
University Hospital of Cleveland, Case Western Reserve University, Ireland Comprehensive Cancer Center, USA.
Am J Obstet Gynecol. 2001 Aug;185(2):370-4. doi: 10.1067/mob.2001.115866.
Recently, pregnancies in patients after radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy have been reported. Radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation has been previously described; however, subsequent outcome and pregnancy has not.
Three patients with cervical carcinoma, 1 with stage IA1 with lymph-vascular space invasion and 2 with stage IA2, were treated with radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation.
All patients underwent the planned procedure with no significant intraoperative or postoperative complications. All patients had return to normal menstrual function. One patient had a successful pregnancy delivered at 39 weeks by cesarean section and is now subsequently pregnant with a second pregnancy.
Radical abdominal trachelectomy is a technically feasible operation that uses operative techniques familiar to the American-trained gynecologic oncologist and results in wider parametrial resection than radical vaginal trachelectomy. In young patients desiring to retain fertility, successful pregnancies after radical abdominal trachelectomy are possible. Intraoperative and postoperative complications are likely to be lower with an abdominal versus a vaginal approach. Long-term survival of patients treated with radical trachelectomy for early invasive cervical cancer are yet to be determined.
最近，已有关于根治性阴道宫颈切除术和腹腔镜盆腔淋巴结清扫术后患者妊娠的报道。先前已描述过保留子宫的根治性腹式宫颈切除术和盆腔淋巴结清扫术；然而，其后续结局及妊娠情况尚未见报道。
3例宫颈癌患者，1例为IA1期伴淋巴血管间隙浸润，2例为IA2期，接受了保留子宫的根治性腹式宫颈切除术和盆腔淋巴结清扫术。
所有患者均按计划完成手术，术中及术后均无严重并发症。所有患者月经功能均恢复正常。1例患者成功妊娠，39周时行剖宫产分娩，目前再次妊娠。
根治性腹式宫颈切除术是一种技术上可行的手术，采用了美国培训的妇科肿瘤学家熟悉的手术技术，与根治性阴道宫颈切除术相比，能更广泛地切除宫旁组织。对于希望保留生育能力的年轻患者，根治性腹式宫颈切除术后成功妊娠是可能的。与经阴道手术相比，经腹手术的术中及术后并发症可能更低。早期浸润性宫颈癌行根治性宫颈切除术后患者的长期生存情况尚待确定。
