宫颈上皮内瘤变及其治疗对妊娠的影响

Impact of cervical intraepithelial neoplasia and its treatments on pregnancy

宫颈鳞状上皮内瘤变是一种和HPV感染有关的宫颈癌前病变。根据病变程度分为低度和高度鳞状上皮内病变，其中低度病变包括HPV感染和CIN1，高度病变包括CIN2-3。HPV感染和宫颈上皮内瘤变是一种生育年龄妇女常见的妇科疾病，HPV感染、宫颈病变本身及其治疗对妊娠的影响倍受关注。HPV感染在妊娠期间可能增加，经阴道分娩者新生儿暴露于HPV的机会增多，尚不能下结论对所有HPV感染者均采用剖宫产的分娩方式。妊娠期间发现CIN1，可以观察并产后随访。如果为CIN2～3，妊娠可能不会加重病变程度，但对阴道镜检查不满意者或高度怀疑浸润癌者应在孕期明确诊断，可于妊娠中期行宫颈锥切术。妊娠中期行宫颈锥切术可能使剖宫产率增加。CIN保守治疗对于患者受孕能力无显著的影响；宫颈冷刀锥切及LEEP锥切可能增加早产率，早产率的增加可能和胎膜早破的发生有关。

Cervical intraepithelial neoplasia is a preinvasive lesion of cervical carcinoma associated with HPV infection. It can be classified as low or high grade according to the degree of the lesion. Low grade lesion includes HPV infection and CIN1, and high grade lesion includes CIN2-3. HPV infection and CIN have become very common among fertile women, so more and more attention has been paid to the influence that HPV infection, cervical lesion and their treatments would have on pregnancy. HPV infection may increase during pregnancy period. Tough there will be more chances for the vaginal delivery infants to be exposed to HPV, it is not proper to draw a conclusion that cesarean must be performed for all HPV infected pregant women. If CIN1 is found during pregnancy, observation and close follow-up post partum should be advised. Pregnancy may not deteriorate CIN2-3, but clear diagnosis should be made during pregnancy if colposcopy examination result is not satisfactory or great doubt for invasive cancer exits. In this case, conization during the second semester of the pregancy is advised, which may increase the cesarean rate. Conservative therapy for CIN has not significant influnce on fertility, while cold knife conization and LEEP conization may increase the premature delivery rate, which may be associated with premature ruption of fetal membrane.