宫颈锥切术对生育力和妊娠结局的影响及改善措施

Impact of Cervical Conization on Fertility and Pregnancy Outcomes and Improve Measures

宫颈癌是女性最常见的妇科恶性肿瘤,随着三级预防及筛查工作的普及,宫颈癌发病率逐渐下降,育龄期妇女宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)的检出率也逐渐增加。宫颈锥切术是诊断和治疗CIN的重要方法,宫颈冷刀锥切术(cold knife conization,CKC)和宫颈环形电切术(loop electrosurgical excision procedure,LEEP)是常用的术式。近年多项研究表明宫颈锥切术不显著影响生育力,但与一些不良妊娠结局的发生有关,如早产、胎膜早破和剖宫产等。不良妊娠结局发生的风险与锥切手术方式、切除范围、术后妊娠间隔时间有关。术后不良妊娠结局的发生风险随着锥切范围的增加而增加。LEEP与CKC治疗CIN疗效相当,但LEEP术后妊娠结局优于CKC。为减少不良妊娠结局的发生,降低病变复发率,可延长术后避孕时间、加强妊娠期监测,必要时行宫颈环扎术和接种人乳头瘤病毒(human papilloma virus,HPV)疫苗等。

Cervical cancer is the most common gynecological malignancy in women.With the widespread adoption of tertiary prevention and screening,the incidence of cervical cancer has been gradually decreasing,while the detection rate of cervical intraepithelial neoplasia(CIN)in women of reproductive age has been gradually increasing.Cervical conization is an important method for the diagnosis and treatment of CIN,of which cold knife conization(CKC)and loop electrosurgical excision procedure(LEEP)are commonly used.In recent years,several studies have shown that cervical conization does not significantly affect fertility,but is associated with the occurrence of some adverse pregnancy outcomes,such as preterm delivery,premature rupture of membranes,and cesarean section.The risk of adverse pregnancy outcomes is associated with the conization procedure,the extent of resection,and the postoperative pregnancy interval.The incidence of postoperative adverse pregnancy outcomes increased with the increase in the extent of conization.The efficacy of LEEP and CKC in the treatment of CIN was comparable,but the postoperative pregnancy outcomes of LEEP were better than those of CKC.To reduce the incidence of adverse pregnancy outcomes and decrease the recurrence rate of the lesions,postoperative contraception can be extended,pregnancy monitoring can be strengthened,and if necessary,cervical cerclage and human papilloma virus(HPV)vaccine can be performed.