Scrivener Claire Grace, Gornall Robert, Rolland Philip
Department of Health Sciences, University of Bristol, Bristol, UK.
Department of Gynaecology, Cheltenham General Hospital, Cheltenham, UK.
BMJ Case Rep. 2016 Jun 28;2016:bcr2016214627. doi: 10.1136/bcr-2016-214627.
A 34-year-old nullipara, wishing to start a family, presented to colposcopy clinic. Her most recent cervical cytology result showed high-grade dyskaryosis. Having undergone four large loop excisions of the transformation zone during the past 6 years, this woman had no remaining vaginal cervix. In order to excise presumed high-grade cervical intraepithelial neoplasia while mitigating obstetric risk, she underwent a simple vaginal trachelectomy and isthmic cerclage. 6 months later, the patient had a negative test of cure. 7 months following surgery she became pregnant naturally. At 29 weeks she had antenatal sepsis of unknown cause, which was treated with intravenous antibiotics. She delivered by caesarean section at 37 weeks and now has a healthy child. This report will discuss the obstetric impact of colposcopic treatment, and simple vaginal trachelectomy as a fertility-sparing treatment option for women who have had multiple loop excision procedures to treat premalignant lesions.
一名34岁未育女性，希望生育，前往阴道镜诊所就诊。她最近的宫颈细胞学检查结果显示为高级别核异质。在过去6年中，该女性接受了4次宫颈转化区大环形切除术，已无阴道宫颈残留。为了切除疑似高级别宫颈上皮内瘤变同时降低产科风险，她接受了单纯阴道宫颈切除术及峡部环扎术。6个月后，患者治愈检查结果为阴性。术后7个月她自然受孕。孕29周时，她出现原因不明的产前败血症，接受了静脉抗生素治疗。她在37周时行剖宫产分娩，现育有一名健康婴儿。本报告将讨论阴道镜治疗的产科影响，以及单纯阴道宫颈切除术作为一种保留生育功能的治疗选择，用于那些接受过多次环形切除术治疗癌前病变的女性。
