保留生育功能患者宫颈环形电切术治疗宫颈鳞状上皮内病变临床疗效及再妊娠结局

Clinical efficacy of cervical loop electrosurgical excision procedure for treating patients with cervical squamous intraepithelial lesions who wanted fertility-preserving and their subseguent pregnancy outcomes

目的:探讨宫颈环形电切术(LEEP)治疗需保留生育功能的宫颈高级别鳞状上皮内病变患者的临床疗效及其妊娠结局。方法:收集2014年6月-2019年6月本院收治的159例需保留生育功能的宫颈高级别鳞状上皮内病变患者,根据手术方式的差异分为LEEP组(n=81)和冷刀组(n=78),分别行LEEP手术或冷刀锥切术。对比两组手术情况、术后并发症及复发情况、妊娠结局以及分娩方式。结果:LEEP组手术时间(10.69±2.26min)、术中出血量(12.36±1.06ml)、愈合时间(27.39±4.68d)以及住院时间(4.25±1.33d)均少于冷刀组,术后并发症总发生率(9.9%)低于冷刀组(21.8%),术后1年复发率(9.0%)高于冷刀组(1.2%)(均P<0.05);术后再妊娠发生流产率、足月产率及异位妊娠率两组无差异(P>0.05),LEEP组再妊娠分娩产程时间、早产率及胎膜早破率低于冷刀组、新生儿体质量高于冷刀组(P<0.05),分娩方式两组无差异(P>0.05)。结论:对需保留生育功能宫颈高级别鳞状上皮内病变患者,LEEP术治疗疗效确切,可有效减少对患者宫颈组织损伤,有助于术后恢复并改善妊娠结局,且术后并发症发生率更低。

Objective: To explore the clinical efficacy of cervical loop electrosurgical excision procedure(LEEP) for treating patients with squamous intraepithelial lesions who wanted fertility-preserving, and to study the postoperative pregnancy outcomes of these patients. Methods: 159 patients with cervical squamous intraepithelial lesions who wanted fertility-preserving from June 2014 to June 2019 were collected and were divided in group A(81 patients with LEEP) and group B(78 patients with cold knife cervical conical resection) according to different surgical methods. The surgical status, the postoperative complications, the recurrence of the cervical squamous intraepithelial lesions, the postoperative pregnancy outcomes and delivery model of the patients were compared between the two groups. Results: The operative time(10.69±2.26 min), the intraoperative blood loss(12.36±1.06 ml), the healing time(27.39±4.68 d), and the time of hospital stay(4.25±1.33 d) of the patients in group A were significantly less than those of the patients in group B. The total incidence of postoperative complications(9.9%) of the patients in group A was significantly lower than that(21.9%) of the patients in group B. The recurrence rate of the cervical squamous intraepithelial lesions(9.0%) of the patients within 1 year after surgery in group A was significantly higher than that(1.2%) of the patients in group B(P<0.05). There were no significant differences in the rates of the abortion, the full-term birth, and the ectopic pregnancy of the patients with postoperative pregnancy between the two groups(P>0.05). The duration of labor, the premature delivery rate, and the premature rupture rate of membranes of the patients with postoperative pregnancy in group A were significantly lower than those of the patients in group B, and the newborn body weight of the patients with postoperative pregnancy in group A was significantly higher than that of the patients in group B(P<0.05).There was no significant difference in delivery model of the postoperative pregnancy of the patients between the two groups(P>0.05).Conclusion:As for the patients with high-g rade squamous intraepithelial lesions of the cervix who need to preserve fertility,LEEP treatment has exact effectiveness,which can effectively reduce the damage to their cervical tissue,help their recovery after surgery,and can improve their subseguent pregnancy outcomes,with lower incidence of postoperative complications.