宫颈环形电切术治疗宫颈上皮内瘤变对妊娠结局影响的临床研究

Effect of Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia on Pregnancy Outcome

目的:探讨宫颈环形电切术(LEEP)治疗宫颈上皮内瘤变(CIN)对妊娠结局的影响。方法:选取2006年8月至2011年2月因CIN在重庆市妇幼保健院宫颈专科接受LEEP治疗,并有生育计划的患者228例,同时选取同期有生育计划的健康妇女400例作为对照组,随访两组妇女妊娠情况。结果:①实验组228例患者共获得179次妊娠,受孕率78.51%,对照组共获得321次妊娠,受孕率80.25%,两组比较差异无统计学意义(P>0.05)。②实验组92例患者妊娠时限超过20周;对照组225例妊娠时限超过20周,两组孕妇在妊娠时间、早产率、新生儿体重、胎膜早破发生率、宫颈裂伤率等方面差异均无统计学意义(P>0.05)。③实验组剖宫产率为79.12%(72/91),明显高于对照组(54.67%,123/225),差异有统计学意义(P<0.01)。去除以社会因素为指征的剖宫产患者,两组剖宫产率比较差异无统计学意义(P>0.05)。④实验组中宫颈锥切深度与分娩孕周呈负相关(r=-0.438,P<0.05)。结论:LEEP治疗CIN是可行的,正确掌握手术适应证与手术切除深度与范围,对其后的妊娠结局无明显影响。

Objective ：To evaluate the effect of the loop electrosurgical excision procedure（LEEP）for Cervical Intraepithelial Neoplasia（CIN）on the pregnancy outcome. Methods： A retrospective cohort study was performed. From August 2006 to February 2011,228 cases with CIN with birth demand were treated by LEEP in the cervical specialist out-patient of Chongqing maternity and child care center. The pregnancyoutcomes of the patients were followed up. Results： ①The pregnancy rate was 78.51% in experimental group （179/ 228）, and 80.25% in control group（321/400）. No difference was observed between two groups（ P 〉0.05）. ② patients in the experimental group and 225 patients in the control groups had the pregnancy time of more than 20 weeks. Pregnancy time, rate of preterm birth, birth weight, abnormal childbirth incidence, cervical laceration rate in two groups had no significant difference（ P〉0. 05）. ③The cesarean section rate in experimental group was 79.12% （72/91） ,which was significantly higher than that of control group（54.67% ,123/ 225） （P 〈0.01 ）. In spite of the patients with social factors for cesarean section, cesarean section rate between two groups had no significant difference（ P 〉0.05）. ④ln the experimental group,conization depth was negatively correlated with delivery gestational weeks （ r = 0. 438, P 〈 0. 05）. Conclusions： It is feasible to treat CIN with LEEP,with well-controlling of indications and resection depth and scope. There is no obvious influence on the subsequent pregnancy outcome.