宫颈锥切术对宫颈上皮内瘤变患者妊娠及其结局的影响

Clinical analysis of the effect of cervical conization on fertility and pregnancy outcome

目的探讨宫颈锥切术对宫颈上皮内瘤变(CIN)患者妊娠及其结局的影响。方法对北京协和医院妇产科1999年至2005年间收治的111例因 CIN 实施宫颈锥切术的患者进行电话随访,术前无原发不孕、年龄≤40岁、未生育过、有生育要求的35例患者纳入本研究。对35例患者的妊娠时间、妊娠周数、妊娠结局和终止妊娠方式进行回顾性分析。结果 (1)35例患者,年龄23～40岁,平均31岁。35例患者中有25例获得26次妊娠,妊娠率为74%(26/35),与该25例患者宫颈锥切术前的妊娠率(69%)比较,差异无统计学意义(P>0.05)。(2)25例妊娠患者中,1例异位妊娠,4例自然流产。其中已分娩的13例患者中,1例早产行剖宫产术,早产率为8%(1/13);胎膜早破2例,胎膜早破发生率为15%(2/13);无低出生体重儿发生;10例行剖宫产术,剖宫产率为77%(10/13)。(3)已分娩的13例患者中,宫颈锥切高度平均为2.0 cm(1.0～3.0 cm),锥切宽度平均为2.5 cm(1.5～3.0 cm)。结论宫颈锥切术对 CIN 患者的妊娠及其结局无明显影响,也不增加早产和低出生体重儿发生率。

Objective To evaluate the effect of conization for cervical intraepithelial neoplasia on the outcome of subsequent fertility and pregnancy. Methods A retrospective study was performed of patients who underwent conization from 1999 to 2005 in Peking Union Medical College Hospital. The nullipara patients below 40-years old without primary or secondary infertility were followed up. Results Thirty-five patients aged from 23 to 40 years, who had pregnancy desire, were included in the study. The mean age of patients was 31 years. Twenty-five women with 26 pregnancies were identified among the 35 patients, and the pregnancy rate was 74% （26/35）, which was not significantly different from that of the same patients before conization （69%, P 〉0. 05）. Among the 26 pregnancies, there occurred one ectopic pregnancy and four cases of spontaneous abortion. In the 13 delivery cases, there were one premature delivery, two cases of premature rupture of the membrane, and ten cases of cesarean section. The sample height of the cone was less than 2. 0 cm in the nine delivery cases, and the mean width of the cone was over 2. 5 cm. Conclusion No evidence of secondary infertility caused by cervical conization was found. There was also no significant increase in the number of either premature delivery cases or low birth weight infants. The sample height of the cone might play a more important role in the pregnancy outcome than the width, which still needs to be further verified by larger studies.