宫颈LEEP术对HSIL患者妊娠分娩方式及妊娠结局的影响

The effect of loop electrosurgical excision procedure on the outcome of subsequent pregnancies

目的:探讨子宫颈电热圈环切术(LEEP)对分娩方式和妊娠结局的影响。方法:随访观察2006年4月至2012年4月在复旦大学附属妇产科医院采用宫颈LEEP术治疗并成功受孕的的65例宫颈鳞状上皮内高度病变(HSIL)患者的妊娠结局。结果:65例患者中最终完成随访获得妊娠结局者60例,其中8例流产,52例妊娠分娩。52例妊娠分娩者中,顺产10例,剖宫产42例(80.8%),其中8例因胎膜早破或疤痕子宫因素选择剖宫产。有不良妊娠史(包括自然流产、早产、胎膜早破、低出生体重儿及保胎史)者共14例,占23.3%(14/60)。结论:国内HSIL患者LEEP术后剖宫产率高可能与临床医师的错误认识有关;而早产主要发生在锥切术后1年内的妊娠患者,但该结论尚需在较大样本的研究中进一步明确。

Objective：To investigate the effect of loop electrosurgical excision proce-dure（ LEEP ） on future pregnancy outcome. Methods：A retrospective cohort study was per-formed using cervical HSIL patients who received LEEP and got subsequent pregnancies at the Obstetrics ＆ Gynecology Hospital,Fudan University between April. 2006 and April. 2012. Re-sults：Out of 65 patients enrolled into the study,only 60 patients had follow-up pregnancy out-come available and therefore underwent analysis. 10（19. 2%） had spontaneous labor and 42 （80. 8%） had cesarean section,of whom 34 chose elective cesarean section for themselves for no medical reason. 14 （23. 3%） had adverse pregnancy history,including spontaneous abor-tion,preterm delivery,premature rupture of membranes,low birth weight and threatened abor-tion. Conclusions：The rate of cesarean section among cervical HSIL patients who had received LEEP was abnormally high,which might due to the clinician＇s mistaken belief. Most preterm de-liveries occurred within the first year after LEEP,but additional large sample clinical trials will be required to verify these initial results.