以術前輔助化學治療加生育保存手術治療Ib2期前子宮頸癌

Neoadjuvant chemotherapy follow by fertility sparing surgery in cervical cancer size 2-4 cm

子宮頸癌第Ib2期（FIGO，2018，2-4 cm）的標準治療方法為根除性子宮切除和後腹膜淋巴結摘除，此會致患者喪失生育能力，造成情緒上的不寧。最近研究認為，術前輔助化療後再行生育保存手術，對治療腫瘤的效果不錯，懷孕的結果亦能接受。術前輔助化療能減少腫瘤大小、淋巴結侵犯和遠端病灶轉移，目前統計術前化療子宮頸癌的有效率約70%。生育保存手術的方法有子宮頸錐狀切片、簡單子宮頸摘除、根除性陰道子宮頸摘除和根除性腹式子宮頸摘除，但是這些手術會造成子宮頸閉鎖不全、子宮頸狹窄、晚期流產和早產等，因此術前必須與患者說明白，且由專科團隊來照顧，以提升療效。

The standard surgery in cervical cancer stage Ib2 (FIGO, 2018, 2-4 cm) is based on aradical hysterectomy and retroperitoneal lymphadenectomy, thereby depriving patients of fertility ability which results in long-lasting emotional and physical distress. Recently, prelimary data on neoadjuvant chemotherapy followed by fertility sparing surgery docamented that offer very good oncologic outcome and acceptable obstetrical outcome. Neoadjuvant chemotherapy is associated with decreased tumor size, lymph node involvement and distant metastases. Globally, the reported response rate to neoadjuvant chemotherapy is in the region of 70%. There are anumber of surgical procedures utilized for fertility surgery for cervical cancer, including cervical conization, simple trachelectomy, radical vaginal trachelectomy and radical abdominal trachelectomy. However, these approaches can be associated with obstetric complications such as cervical insufficiency, cervical stenosis, late miscariage and premature labor. It is important to provide support services and amulti-disciplinary to care these patients.