宫颈环形电切术治疗高级别鳞状上皮内病变的临床效果及对患者妊娠结局的影响

Effect of cervical loop electrosurgical excision procedure in treating high-grade squamous intraepithelial lesion and its impact on pregnancy outcomes

目的探讨宫颈环形电切术(LEEP)治疗高级别鳞状上皮内病变(HSIL)的临床效果及其对患者妊娠结局的影响。方法收集接受宫颈LEEP治疗的有生育需求的308例HSIL患者作为观察组研究对象,并采用随机抽签方式从因其他原因就诊且无宫颈LEEP手术史的女性患者中抽取100例作为对照组。2组患者均接受定期随访。统计观察组术后病灶完全切除、病灶残留和复发情况,对比2组自然妊娠情况、妊娠期间不良妊娠事件发生情况、分娩方式和分娩结局。结果308例HSIL患者中,284例病灶完全切除,病灶残留率3.90%,切缘阳性率16.56%,复发率3.57%。切缘阴性与切缘阳性患者的病灶残留及复发率间差异显著(P<0.05)。观察组患者首次成功妊娠率95.80%、初产率91.63%与对照组的92.00%、86.96%比较,组间差异无统计学意义(P>0.05)。2组人工流产、胚胎停止发育和其他原因所致流产、胎膜早破、早产和低体质量儿的发生率差异无统计学意义(P>0.05),但观察组剖宫产患者占比显著高于对照组(P<0.05)。LEEP术后至成功妊娠时间间隔对早产影响的受试者工作特征曲线(ROC)曲线下面积为0.83,在早产中具有较好预测价值,灵敏度83.40%,特异度为67.70%,最佳切割值为13.70。LEEP术后至初次成功妊娠间隔≥13.70个月孕妇的早产发生率显著低于<13.70个月孕妇(P<0.05)。结论HSIL患者在宫颈LEEP治疗后存在病灶残留及复发情况,尤其是切缘阳性患者中,而宫颈LEEP操作对有生育需求女性的生育功能及妊娠结局无明显影响,但术后至妊娠时间间隔短会增大早产风险。

Objective To investigate the clinical effect of loop electrosurgical excision procedure(LEEP)in the treatment of high-grade squamous intraepithelial lesion(HSIL)and its effect on the pregnancy outcomes.Methods A total of 308 patients with HSIL who had fertility needs and treated with cervical LEEP in our hospital were enrolled in the observation group,and 100 female patients who admitted for other reasons and had no history of cervical LEEP surgery were enrolled as control group by randomly draw method.Patients of both groups received regular follow-up.Complete resection of the lesion,residual lesions and recurrence was recorded in the observation group.The natural pregnancy,the occurrence of adverse pregnancy events during pregnancy,the mode and the outcomes of delivery were compared between the two groups.Results Out of 308 HSIL patients,the lesions of 284 patients were completely resected,with the residual rate of 3.90%,the positive margin rate of 16.56%,and the recurrence rate of 3.57%.There were significant differences in the residual and recurrence rates between margin-negative and positive patients(P<0.05).There were no statistically significant differences between the observation group and the control group in the first successful pregnancy rate(95.80%vs.92.00%)and the initial birth rate(91.63%vs.86.96%)(P>0.05).There were no significant differences in the incidences of abortion,embryonic cessation,and occurrence rate of abortion,premature rupture of membranes,premature delivery and low birth weight caused by other reasons between two groups(P>0.05),but the proportion of patients with cesarean section in the observation group was significantly higher than that in the control group(P<0.05).The area under the receiver operating characteristic(ROC)curve of interval from postoperative LEEP to successful pregnancy was 0.83,which had good predictive value in preterm birth,with an 83.40%sensitivity and a 67.70%specificity,and 13.70 of optimal cut value.The incidence of preterm birth was significantly lower in pregnant women with interval from postoperative LEEP to successful pregnancy≥13.70 months than those<13.70 months(P<0.05).Conclusion Patients with HSIL have residual lesion and recurrence after LEEP treatment,especially for margin-positive patients.Cervical LEEP operation has no significant effect on fertility and pregnancy outcomes in women with fertility needs.However,short interval between postoperation and pregnancy increase the risk of preterm birth.