LEEP术后患者宫颈长度变化与妊娠及不良结局分析

Analysis of cervical length change,pregnancy rate and adverse pregnancy outcomes in young patients after LEEP

目的:探讨行宫颈环形电切术(LEEP)年轻患者术后宫颈长度变化及对妊娠结局的影响。方法:将2018年2月-2019年2月本院行LEEP术治疗的宫颈鳞状上皮内瘤变患者105例为病例组,随机选同期行孕前体检且无LEEP术史妇女42例为对照组。比较病例组LEEP术前和术后6个月宫颈长度,及两组妊娠及不良妊娠结局情况。结果:病例组患者LEEP术后6个月宫颈长度(28.13±2.36mm)短于术前(29.76±2.45mm),且孕前(28.2±2.3 mm)短于对照组(29.9±2.3mm)(P<0.05);术后妊娠者发生晚期流产率(18.0%)高于对照组(2.6%),早产率(41.0%)和未足月胎膜早破发生率(19.1%)高于对照组(4.8%、2.4%)(P<0.05)。结论:患者LEEP术后宫颈长度虽变短但仍可保存较好的生育功能,但宫颈长度变短可增加妊娠后晚期流产、早产和未足月胎膜早破等发生率,对有生育要求的患者应明确手术指征,尽可能多的保留宫颈组织以提高生育几率。

Objective:To investigate the cervical length change of young patients after loop electrosurgical excisional procedure(LEEP),and to study its influence on pregnancy outcomes.Methods:105 patients with cenvical squamous intraepithelial lesion(CIN)underwent LEEP were selected in study group,and 42 healthy pregnant women underwent prenatal physical examinations were selected in control group from February 2018 to February 2019.The cervical length of women in the study group were compared between before LEEP and 6 months after LEEP.The rates of pregnancy and adverse pregnancy outcomes of women were compared between the two groups.Results:At 6 months after LEEP in the study group,the cervical length(28.13±2.36mm)of patients was significant shorter than that(29.76±2.45mm)before LEEP.The cervical length(28.2±2.3mm)of patients in the study group before pregnancy was significant shorter than that(29.9±2.3mm)of patients in the control group(P<0.05).The rates of late abortion,preterm birth rate,and membranes premature rupture of patients in the study group after operation were 18.0%,41.0%,and 19.1%,respectively,which were significant higher than those(2.6%,4.8%,and 2.4%,respectively)of patients in the control group(P<0.05).Conclusion:The cervical length of young patients with LEEP becomes shorter,which has no effect on fertility function,while the incidences of adverse outcomes,such as abortion during the third trimester of pregnancy,preterm birth,and preterm rupture of membranes,may be increase,so LEEP indications should be confirmed for patients who want to giving birth,and their cervical tissue should be saved as much as possible during LEEP for improving their chances of giving birth.