宫颈锥切术对妊娠结局的影响

Pregnancy outcome after cervical conization

目的探讨宫颈冷刀锥切（cold knife conization，CKC）与环形电切术（loop electrical excision procedure, LEEP）对妊娠结局及分娩方式的影响。方法采用回顾性病例对照研究，分析2004年1月至2010年1月在中山大学附属第一医院及广州市番禺区何贤纪念医院诊断为宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）Ⅱ～Ⅲ并接受宫颈锥切术治疗后的妊娠患者228例，其中行LEEP168例、CKC60例。按年龄、孕次、产次、经济收入相匹配的原则，1：1随机收集同期分娩的健康孕妇为对照组，观察各组的妊娠天数、胎膜早破（premature rupture of membranes，PROM）发生率、终止妊娠方式和新生儿出生体重。结果病例组和对照组的妊娠天数分别为（268．3±26．2）d和（279．4±25．3）d，差异有统计学意义（t=4．60，P〈0．01）；早产率分别为18．0％（41／228）和4．4％（10／228）（χ^2=21．22，P〈0．05）；PROM发生率分别为10．1％（23／228）和1．3％（3／228）（χ^2=16．32，P〈0．05），病例组发生PROM的风险是对照组的8．42倍（OR=8．42，95％CI：2．49～28．44）。2组剖宫产率分别为69．3％（158／228）和39．0％（89／228），差异有统计学意义（χ^2=42．06，P％0．05）。病例组中LEEP组与CKC组妊娠天数分别为（269．8±24．6）d和（260．2±26．5）d，差异有统计学意义（t=4．01，P〈0．01）；早产率分别为13．1％（22／168）和31．6％（19／60）（χ^2=10．34，P％0．05）。新生儿出生体重分别为（3358．5±812．2）g和（3295．9±832．6）g，差异有统计学意义（t=3．08，P〈0．01）；PROM发生率分别为7．1％（12／168）和18．3％（11／60），差异有统计学意义（χ^2=6．10，P〈0．05）。结论宫颈锥切术增加了孕妇早产、PROM发生率；LEEP对妊娠结局的影响小于CKC。因此对有生育要求的患者，应优先考虑LEEP并告知相关风险。

Objective To investigate the effect of cervical knife conization （CKC） or loop electrical excision procedure （LEEP） on the outcome of subsequent pregnancies and mode of deliveries. Methods A retrospective case-control study including 228 women after treatment with LEEP or CKC for cervical intraepithelial neoplasia （CIN）Ⅱ～Ⅲ who gave birth in the First Affiliated Hospital of Sun Yat-sen University and He-xian Memorial Hospital of Pangyu from January 2004 to January 2010 was performed. Patients （n = 228） without cervical surgical history were randomly extracted from the respective hospitals birth registries as controls and were matched by age, gestation, parity and income. The information including gestational age, premature rupture of membranes （PROM）, type of deliveries and birth weight of the two groups were collected. Results The gestational age of women treated with eonization was （268.3±26.2） d, longer than that of the women without surgery （279.4±25.3） d （t=4.60, P〈0.01）. The incidence of preterm birth was 18.0% （41/228） and 4.40/00 （10/228） （χ^2=21,22,P〈0.05）. The incidence of PROM was higher in conizationgroup （10.1%, 23/228） than that （1.3%, 3/228） in control group （χ^2 =16.32, P〈 0.05）. Risk for PROM was almost eight fold （OR=8.42, 95% CI： 2.49-28.44） higher in conization group. Cesarean section rate was higher in conization group （69.3%） than in control group （39.0%） （χ^2=42.06, P〈0.01）. The gestational age of women treated with LEEP was longer than those treated withCKC[（269.8±24.6） d vs （260.2-±26.5） d, t=4.01, P〈0.01]. The incidence of preterm birth was 13. 1%（22/168） and 31.6% （19/60） （χ^22 = 10.34, P〈0.05）. The mean birth weight of women with LEEP was heavier than that with CKC [（3358.5±812.2） g vs （3295.9± 832. 6） g, t=3.08, P〈0.01]. The incidence of PROM （7.1%, 12/168） of woman with CKC was higher than that （1.3%, 11/60） of women with LEEP （χ^2 =6.10, P〈0.05）. Conclusions Conization might increase the incidence of preterm delivery and preterm PROM. LEEP showed less adverse effect on the outcome of subsequent pregnancies than CKC, and was preferred for primigravida, and the risk of treatment should be informed in advance.