宫颈锥切术对患者妊娠结局的影响及不良妊娠结局危险因素分析

Pregnancy outcomes and associated factors of patients undergoing cervical conization

背景宫颈高级别鳞状上皮内病变患者锥切术后仍有部分患者有生育需求,对于这部分患者的治疗及术后管理尚未形成临床共识。目的研究宫颈锥切术对宫颈高级别鳞状上皮内病变患者妊娠结局的影响,并分析不良妊娠结局(早产、剖宫产、低体质量出生儿)的危险因素。方法2017年9月1日—2021年12月31日在解放军总医院第一医学中心进行子宫颈锥形切除术并在术后获得活产的患者65例作为观察组,并收集同时期在解放军总医院产科住院生产的正常患者65例作为对照组,比较两组患者的一般资料(年龄、身高、体质量)和妊娠结局(是否早产、分娩方式),观察组再以锥切高度(病理结果)是否>1.5 cm进行分组,分析锥切高度与早产、剖宫产率等妊娠结局的关系,寻找锥切术后不良妊娠结局的危险因素。结果锥切术后妊娠早产率改变(P<0.05)。锥切高度>1.5 cm与≤1.5 cm的剖宫产率、早产发生率差异无统计学意义(P>0.05)。锥切高度>1.5 cm是锥切术后不良妊娠结局的独立关联因素(OR=3.868,95%CI:1.256~11.918)。结论宫颈电刀锥切术后妊娠的早产率增加,对于有生育要求的患者,在切净病灶的前提下可尽量保证锥切高度不超过1.5 cm,在手术半年后备孕,妊娠过程进行严密的监测和必要的宫颈环扎术可避免不良妊娠事件的发生。

Background The need for pregnancy in patients with high grade squamous intraepithelial lesion after conization is increasing year by year,while there is no clinical consensus on the treatment and postoperative management of patients with fertility needs.Objective To study the effect of conization of cervix on pregnancy outcomes in patients with high grade squamous intraepithelial lesion and analyze the risk factors for adverse pregnancy outcomes(preterm birth,cesarean section,low birth weight).Methods A retrospective analysis was performed on 65 patients who underwent conization of cervix in the First Medical Center of Chinese PLA General Hospital from September 1,2017 to December 31,2021,and the patients were served as the observation group.Another 65 patients who gave birth at the Obstetrics Department of Chinese PLA General Hospital during the same period were collected as the control group.The general information(age,height,weight)and pregnancy outcome(preterm birth,mode of delivery)of the observation group and the control group were compared.The observation group was divided into two groups based on whether the conization height(pathological results)was greater than 1.5 cm.The general data and the pregnancy outcomes such as premature birth and cesarean section rate of the two groups were compared,and the factors associated with adverse pregnancy outcomes after conization were explored.Results The rate of preterm pregnancy after cervical conization was changed(P<0.05).There was no significant difference in the rate of cesarean section and the incidence of premature birth when the height of conization was greater than 1.5 cm(P>0.05).Conization height greater than 1.5 cm was associated with adverse pregnancy outcomes after cervical conization(OR=3.868,95%CI:1.256-11.918).Conclusion The preterm birth rate of pregnancy increases after electrosurgical coning of cervix.For patients with fertility requirements,the height of conization should not exceed 1.5 cm under the premise of removing the lesion,and pregnancy should be reserved after half a year of surgery.Strict monitoring of the pregnancy process and necessary cervical cerclage can avoid adverse pregnancy events.