Alouini Souhail, Rida Khalid, Mathevet Patrice
Service de Chirurgie Gynécologique, Pavillon L. Hôpital Edouard Herriot, Lyon, 69003, France.
Gynecol Oncol. 2008 Mar;108(3):472-7. doi: 10.1016/j.ygyno.2007.12.006. Epub 2008 Jan 16.
To define a strategy for lymph node staging in cervical carcinoma complicating pregnancy.
Eight patients undergoing laparoscopic pelvic (+/-para-aortic) lymphadenectomy during pregnancy (12 to 32 weeks of gestation) between 1994 and 2006 were included. The FIGO stage of cervical cancer was IB1 for five women, IB2 for two women, and IIIA for one woman. The histological type was squamous in five cases and adenocarcinoma in three cases.
All of the laparoscopic procedures were successful; there was no mortality, morbidity, or conversion. There were no complications for either mother or child related to the general anesthesia. The mean number of lymph nodes removed was 18 (range 11-28). The pelvic lymph nodes were not invaded in 5 patients (4 IB1, 1 IB2). Cancer treatment was delayed for four out of five patients until after fetal extraction. One patient aborted after a radical trachelectomy. All patients without lymph node metastasis were alive without recurrence at a mean follow-up time of 64+/-39 months. Lymph nodes were involved in three patients (IB1, IB2, IIIA). These patients died from recurrence of the disease. Seven patients out of eight reached fetal maturity and gave birth by caesarean section to healthy babies.
Laparoscopic lymphadenectomy during pregnancy is a safe and effective procedure for lymph node staging in cervical cancer. Laparoscopic pelvic lymphadenectomy can be performed in any trimester of pregnancy. Because the number of patients in this study was small, the safety of the laparoscopic procedures should be confirmed by future studies. Pregnant women who do not have lymph node metastasis may benefit from either delayed cancer treatment after fetal extraction or immediate conservative treatment for early stage cancers. The prognosis is poor for patients with lymph node metastasis, and therefore, these patients should have input into the therapeutic process.
确定妊娠合并宫颈癌患者淋巴结分期的策略。
纳入1994年至2006年间8例在孕期（妊娠12至32周）接受腹腔镜盆腔（±腹主动脉旁）淋巴结清扫术的患者。5例宫颈癌患者的国际妇产科联盟（FIGO）分期为IB1期，2例为IB2期，1例为IIIA期。组织学类型为鳞状细胞癌5例，腺癌3例。
所有腹腔镜手术均成功；无死亡、并发症或中转开腹情况。与全身麻醉相关的母婴均无并发症。切除淋巴结的平均数量为18个（范围11 - 28个）。5例患者（4例IB1期，1例IB2期）盆腔淋巴结未受侵犯。5例患者中有4例癌症治疗推迟至胎儿娩出后。1例患者在根治性宫颈切除术后流产。所有无淋巴结转移的患者在平均随访时间64±39个月时均存活且无复发。3例患者（IB1期、IB2期、IIIA期）有淋巴结转移。这些患者死于疾病复发。8例患者中有7例胎儿成熟并通过剖宫产娩出健康婴儿。
孕期腹腔镜淋巴结清扫术是宫颈癌淋巴结分期的安全有效方法。腹腔镜盆腔淋巴结清扫术可在孕期的任何阶段进行。由于本研究患者数量较少，腹腔镜手术的安全性有待未来研究证实。无淋巴结转移的孕妇可从胎儿娩出后推迟癌症治疗或对早期癌症立即进行保守治疗中获益。有淋巴结转移患者的预后较差，因此，这些患者应参与治疗过程。
