Pandraklakis Anastasios, Thomakos Nikolaos, Prodromidou Anastasia, Oikonomou Maria D, Papanikolaou Ioannis G, Vlachos Dimitrios-Efthimios G, Haidopoulos Dimitrios, Daskalakis Georgios, Rodolakis Alexandros
Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Research Institute and Diabetes Center, Athens, Greece.
Folia Med (Plovdiv). 2020 Sep 30;62(3):453-461. doi: 10.3897/folmed.62.e48736.
Advances in modern medicine have allowed patients with early stage cervical cancer (stages Ia - IIai) to preserve their fertility with oncologic efficacy comparable to previous radical treatments. A variety of conservative-fertility sparing procedures, also known as Fertility Sparing Surgeries (FSS) have been proposed. The present review aimed to provide the current evidence on obstetric outcomes and the prematurity rates as well as to discuss the management modalities of these high-risk pregnancies. Our review of the literature included 3042 women with early cervical cancer, of whom 2838 underwent FSS (204 excluded for oncologic reasons). Almost half of these patients attempted to become pregnant and about two thirds of them achieved at least one pregnancy either spontaneously or with the help of Assisted Reproduction Technologies. Data revealed that 63.9% of these pregnancies resulted in live births, whereas 37.6% of them were preterm. The main cause of preterm births in this subpopulation is the postoperative cervical length restriction that consequently leads to cervical incompetence and ascending infections that eventually lead to (clinical or subclinical) chorioamnionitis. Radical operations such as ART, VRT and MIRT presented with higher prematurity rates. The lack of standardized protocols for the management of pregnancies after FSS precluded reaching to firm results with regards to the efficacy of them in achieving favourable obstetrical outcomes. Further large volume studies are warranted with the intent to acquire standardized guidelines for pregnancies achieved after FSS for early stage cervical cancer.
现代医学的进步使早期宫颈癌（Ia - IIai期）患者能够保留生育能力，其肿瘤学疗效与以往的根治性治疗相当。人们提出了多种保留生育功能的保守手术方法，也称为保留生育功能手术（FSS）。本综述旨在提供有关产科结局和早产率的当前证据，并讨论这些高危妊娠的管理方式。我们对文献的综述纳入了3042例早期宫颈癌女性，其中2838例接受了FSS（204例因肿瘤学原因被排除）。这些患者中几乎一半尝试怀孕，其中约三分之二至少自然怀孕一次或借助辅助生殖技术怀孕一次。数据显示，这些妊娠中有63.9%分娩活婴，而其中37.6%为早产。该亚组早产的主要原因是术后宫颈长度受限，进而导致宫颈机能不全和上行感染，最终导致（临床或亚临床）绒毛膜羊膜炎。诸如ART、VRT和MIRT等根治性手术的早产率更高。FSS后妊娠管理缺乏标准化方案，因此无法就其实现良好产科结局的疗效得出确凿结果。有必要进行进一步的大规模研究，以便为早期宫颈癌FSS后妊娠制定标准化指南。
