宫颈冷刀锥切术对生育能力及妊娠结局的影响

Effect of Cervical Conization on the Outcome of Subsequent Fertility and Pregnancy

目的:探讨宫颈冷刀锥切术对患者生育能力的影响及是否产生不良妊娠结局。方法:收集1998年10月至2008年9月收治的因宫颈上皮内瘤变(CIN)或宫颈原位癌于我院实施宫颈冷刀锥切术且有生育要求的患者96例作为观察组,随机抽取同期孕前门诊的100例无宫颈锥切术史的妇女作为对照组。对两组对象的生育能力、妊娠结局及围生儿情况进行分析。结果:①观察组术后妊娠率(89.6%)与对照组(91.0%)相比,差异无统计学意义(P>0.05)。②观察组剖宫产率(34.7%)高于对照组(20.5%)(P<0.05),两组流产率、阴道试产成功率、产钳助产率、平均产程及各项剖宫产指征比较差异均无统计学意义(P>0.05)。③观察组严重早产发生率(8.0%)和早产胎膜早破发生率(10.7%)高于对照组(1.2%和2.4%)(P<0.05),而观察组新生儿出生体重低于对照组(P<0.05);观察组早产及小于胎龄儿发生率与对照组比较差异无统计学意义(P>0.05);④宫颈锥切术距术后初次妊娠时间间隔<6月组、6～12月组及≥12月组的不良妊娠结局比较,3组差异均无统计学意义(P>0.05);⑤将锥切高度<10mm、10～20mm及≥20mm分成3组,流产率、早产率、早产胎膜早破及小于胎龄儿发生率随宫颈锥切的高度递增,但差异无统计学意义(P>0.05)。结论:宫颈锥切术后对患者妊娠能力无明显影响,但可增加不良围生结局发生率;宫颈锥切术距术后妊娠的时间间隔和锥切高度与不良围生结局无明显关系。

Objective： To evaluate the effect of cervical conization on the outcome of subsequent fertility and adverse pregnancy outcome. Methods：A retrospective study was performed on the medical records of the patients of cervical intraepithelial neoplasia or carcinoma in situ of cervix who underwent conization in Women＇s Hospital,School of Medicine, Zhejiang University from Oct. 1998 to Sep. 2008, and the patients who had pregnancy desire were followed-up, 96 cases were included in the observation group. One hundred healthy women without history of cervical conization for preconception counseling in the hospital over the same period by randomly chosen were collected as control group. The fertility, pregnancy outcomes and per- inatal situation in the two groups were retrospectively analyzed. Results： ~Postoperative pregnancy rate was 89. 6% in the observation group, which was not significantly different from that （91.0%） in control group. （~The rate of cesarean section was 34.7% and 20. 5% in observation group and control group re- spectively,there was significant difference in rate of cesarean section between the two groups（ P 〈0. 05 ）. But the abortion rate, rate of success vaginal trial of production, forceps delivery rate, average stages of la- bor and the various indications of cesarean section were not significant different between the two groups. （The rate of severe preterm （8. 0%） and PPROM （10. 7%） in observation group were significantly higher than those in control group（ 1.2% ＆ 2.4% ） （ P 〈 0.05 ）, and the average birth weight in observation group was lower than that in control group（ P〈O. 05）. The rate of preterm birth and SGA were not statistically dif- ferent between the two groups （P 〉 0. 05）. Time interval between the cervical conization and the subse-quent initial pregnancy ＂less than 6 months＂ group, ＂more than or equal to 6 months but less than 12 months＂ group and ＂more than or equal to 12 months＂ group, the rate of adverse pregnancy outcomes were not significantly different among the three groups （P 〉 0. 05）. ⑤The observation group was divided by cone height into three groups such as the ＂less than 10 mm＂ group, ＂more than or equal to 10mm but less than 20 mm＂ group and ＂more than or equal to 20 mm＂ group, the rate of abortion, preterm birth, PPROM and SGA increased by cone height, but the difference was no statistical significance （P 〉 0. 05）. Conclu- sions.Cervical conization didn＇t significantly affect patients＇ fertility, but it could increase the incidence of ad- verse pregnancy outcome. The time interval between the cervical conization and the subsequent initial preg- nancy and cone height and adverse pregnancy outcomes were not significantly correlated.