Bull-Phelps Shawna L, Garner Elizabeth I O, Walsh Christine S, Gehrig Paola A, Miller David S, Schorge John O
Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., J7.124, Dallas, TX 75390-9032, USA.
Gynecol Oncol. 2007 Nov;107(2):316-9. doi: 10.1016/j.ygyno.2007.06.021. Epub 2007 Aug 8.
Cervical adenocarcinoma in situ (AIS) is a precursor of invasive disease that is increasing in incidence primarily among reproductive-age women of low parity. Conization is an alternative to hysterectomy that allows future pregnancy, but has an inherent risk of residual AIS. The purpose of this study was to determine the outcomes of patients treated by this fertility-sparing strategy over an extended period of surveillance.
Women diagnosed with cervical AIS who underwent primary fertility-sparing surgery with either loop excision or cold knife conization between 1993 and 2001 were identified at three institutions. A retrospective medical record review was performed. Patients 40 years of age and older and those undergoing hysterectomy within 12 months of diagnosis were excluded.
A total of 101 women underwent cone biopsy and expectant management. The median age was 29 years. Fifty-seven percent were nulliparous and 23% primiparous. Cold knife conization was most commonly performed (69 vs. 32 procedures) and had a higher efficacy of achieving negative margins (72% vs. 47%; P=0.036). Thirty-five women had a total of 49 pregnancies during a mean follow-up of 51 months. Thirty-five gestations were delivered at term. There were two preterm births, eight spontaneous miscarriages, three elective terminations, and one ectopic pregnancy. Thirty-six patients had a repeat cone biopsy. Five ultimately underwent hysterectomy. No invasive cervical adenocarcinomas were observed during the study interval.
Fertility-sparing surgery enables women with cervical AIS to achieve pregnancy with minimal risk of developing invasive disease during surveillance.
宫颈原位腺癌（AIS）是浸润性疾病的前驱病变，其发病率主要在低生育次数的育龄妇女中呈上升趋势。锥切术是子宫切除术的一种替代方法，可保留未来的生育能力，但存在残留AIS的固有风险。本研究的目的是确定在长期监测中采用这种保留生育功能策略治疗的患者的结局。
在三家机构中识别出1993年至2001年间诊断为宫颈AIS并接受环形切除或冷刀锥切术进行初次保留生育功能手术的女性。进行了回顾性病历审查。排除40岁及以上的患者以及在诊断后12个月内接受子宫切除术的患者。
共有101名女性接受了锥切活检并进行了期待治疗。中位年龄为29岁。57%为未生育女性，23%为初产妇。最常进行冷刀锥切术（69例对32例），且切缘阴性的成功率更高（72%对47%；P=0.036）。35名女性在平均51个月的随访期间共怀孕49次。35例足月分娩。有2例早产、8例自然流产、3例选择性终止妊娠和1例异位妊娠。36例患者进行了重复锥切活检。5例最终接受了子宫切除术。在研究期间未观察到浸润性宫颈腺癌。
保留生育功能手术使宫颈AIS女性能够怀孕，且在监测期间发生浸润性疾病的风险最小。
