子宫颈高级别鳞状上皮内病变行环形电刀切除术后对妊娠结局的影响

Effect of loop electrosurgical excision procedure on the outcome of subsequent pregnancy after surgery

目的探讨患者孕前因宫颈高级别鳞状上皮内病变(HSIL)行环形电刀切除(loop electrosurgical excision procedure,LEEP)术后,对后续妊娠结局的影响。方法选取2018年10月至2019年10月上海市长宁区妇幼保健院收治的因HSIL(CIN2或CIN3)孕前行LEEP术且术后随访宫颈无阳性发现的55例孕妇作为研究组,同期选取孕前未行LEEP术、液基薄层细胞学检查(TCT)无阳性发现的55例孕妇作为对照组。2组孕妇均定期接受产检并给予健康指导,且皆在该院分娩,对2组孕妇的妊娠结局及分娩方式进行比较。结果研究组孕妇的不良妊娠结局率和围生儿不良分娩结局率与对照组相比,差异无统计学意义(P>0.05);研究组孕妇的产钳助产率、剖宫产率分别为21.73%、54.34%,高于对照组的4.00%、30.00%,而研究组孕妇的阴道产率为45.65%,低于对照组的70.00%,差异均有统计学意义(P<0.05)。结论既往采用LEEP术治疗的HSIL产妇,对其术后的妊娠结局未见影响,但会增加剖宫产率及产钳助产率,这可能与LEEP术后宫颈疤痕的形成及宫颈长度、弹性的改变有关。

Objective To investigate the effect of loop electrosurgical excision procedure(LEEP)on the outcome of subse⁃quent pregnancy after surgery due to high⁃grade squamous intraepithelial lesion(HSIL).Methods 55 pregnant women who received LEEP due to HSIL(CIN2 or CIN3)before pregnancy during hospitalization from October,2018 to October,2019 in the Department of Obstetrics and Gynecology of the hospital and had no positive finding by medical follow⁃ups were enrolled as the study group,while an⁃other 55 pregnant women who did not have LEEP and positive finding by TCT were recruited as the control group.The 2 groups of pregnant women all received regular prenatal examination and healthcare instructions,and had deliveries in the hospital.The pregnant outcome and mode of labor were compared between the two groups.Results There was no statistical significance in the rate of adverse pregnancy outcome and the rate of perinatal adverse childbirth outcome in the study group,when compared with the control group(P>0.05).The rates of forceps delivery and cesarean section in the study group were 21.73%and 54.34%,which were higher than those of the control group(4.00%and 30.00%),while the rate of vaginal delivery in the study group was 45.65%,which was lower than that of the control group(70.00%),with statistical significance(P<0.05).Conclusion For HSIL women who received LEEP surgery,no effect could be seen on pregnancy outcome after surgery.However,rates of cesarean section and forceps delivery would increase,which might be related to the formation of cervical scar and the change of cervical length and elasticity after LEEP surgery.