Liu Chih-Ku, Huang Kuan-Gen, Chen Ming-Jer, Lu Chien-Hsing, Hwang Sheau-Feng, Sun Lou, Hsu Shih-Tien
Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Taiwan.
Gynecol Minim Invasive Ther. 2023 Dec 7;13(1):4-9. doi: 10.4103/gmit.gmit_34_23. eCollection 2024 Jan-Mar.
Although the incidence of most cancers increases with age, a considerable number of patients receive a diagnosis of cancer during their reproductive years. Young women wishing to get pregnant after cancer treatment should be provided consultation for fertility preservation and possible options. In patients with cervical cancer, hysterectomy is often inevitable because the uterus is located too close to the cervix. For young patients with cervical cancer who desire to get pregnant and whose lesion is confined to the cervix, sparing the uterus and, partially, the cervix should be prioritized as much as possible, while simultaneously ensuring favorable oncologic outcomes. In this review, we explore how to choose an adequate fertility-preserving procedure to achieve a balance between favorable oncologic outcomes and fertility and management during pregnancy after a radical trachelectomy in women with early-stage cervical cancer. For patients who require hysterectomy or radiation, evaluation of the ovarian condition and laparoscopic ovarian transposition followed by the use of artificial reproduction techniques and pregnancy by surrogacy should be discussed as options to achieve a successful pregnancy.
尽管大多数癌症的发病率会随着年龄增长而升高，但仍有相当数量的患者在生育年龄被诊断出患有癌症。希望在癌症治疗后怀孕的年轻女性应接受关于生育力保存及可能选择的咨询。对于宫颈癌患者，由于子宫位置离宫颈过近，子宫切除术往往不可避免。对于渴望怀孕且病变局限于宫颈的年轻宫颈癌患者，应尽可能优先保留子宫及部分宫颈，同时确保良好的肿瘤学预后。在本综述中，我们探讨如何选择合适的生育力保存手术，以在早期宫颈癌女性行根治性宫颈切除术后实现良好肿瘤学预后与生育及孕期管理之间的平衡。对于需要子宫切除术或放疗的患者，应讨论评估卵巢状况、腹腔镜卵巢移位，随后采用辅助生殖技术以及代孕妊娠等作为实现成功妊娠的选择。
