绝经期患者子宫颈环形电切术后子宫颈狭窄粘连的临床特征分析
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摘要
目的:分析绝经期患者子宫颈环形电切术(LEEP)后子宫颈狭窄粘连的临床特征及其与子宫颈狭窄粘连的关系。方法:回顾性分析2016年1～12月进行LEEP手术的471例绝经期患者的临床资料。通过LEEP术后第6个月阴道镜检查,将这471例绝经期患者分为发生和未发生子宫颈狭窄粘连两组,比较两组患者的一般情况指标(年龄、绝经时间、孕产史、阴道分娩史、是否有LEEP手术史)、围手术期指标(手术指征、术前白细胞值和中性粒比率、术中出血量、手术时间、LEEP锥切的宽度和深度)和术后情况指标(术后出血排液停止时间、术后第6月阴道超声测子宫颈长度)。结果:471例研究对象中,LEEP术后第6月发生子宫颈狭窄粘连的有251例(53.29%),其中包括57例(12.10%)子宫颈粘连;无子宫颈狭窄粘连220例(46.71%)。比较两组患者的平均年龄、绝经时间长短、孕次和产次、术前白细胞值和中性粒细胞比率、术中出血量、LEEP锥切宽度值、手术指征和术后第6月子宫颈长度值,差异均无统计学意义(P>0.05)。无阴道分娩史者LEEP术后子宫颈狭窄粘连的发生率高于有阴道分娩史者,差异有统计学意义(81.58%vs 47.85%,P<0.05);有LEEP手术史者术后患者子宫颈狭窄粘连的发生率高于无LEEP手术史者,差异有统计学意义(87.23%vs 49.53%,P<0.05);手术时间>5分钟者,术后发生子宫颈狭窄粘连的发生率高于手术时间≤5分钟者,差异有统计学意义(75.32%vs 48.98%,P<0.05);LEEP锥切深度>15 mm者术后子宫颈狭窄粘连的发生率高于锥切深度≤15 mm者,差异有统计学意义(85.65%vs 20.51%,P<0.05);术后出血排液停止时间>4周者,术后发生子宫颈狭窄粘连的发生率高于术后出血排液停止时间≤4周者,差异有统计学意义(67.43%vs 41.11%,P<0.05)。结论:绝经期患者LEEP术后子宫颈狭窄粘连与阴道无分娩史、LEEP锥切深度、手术时间、术后出血排液停止时间和子宫颈LEEP手术史有关。对绝经期患者进行子宫颈疾病的LEEP手术治疗,需要掌握手术深度,避免对颈管组织过度灼伤,避免长时间大范围电凝止血,加强止血和预防感染措施缩短术后出血流液的时间可降低子宫颈狭窄粘连的发生。
Objective:To analyze the clinical characteristics of cervical stenosis and adhesion after loop electrosurgical excision procedure(LEEP) in menopausal patients.Methods:The clinical data of 471 menopausal patients undergoing LEEP surgery from January 2016 to December 2016 were analyzed retrospectively.Through colposcopy examination at the 6 th month after LEEP operation,471 menopausal patients were divided into two groups whether there were cervical stenosis and adhesion.The general indicators(age,menopause time,pregnancy history,vaginal delivery history,LEEP operation history),perioperative indicators(operation indication,preoperative white blood cell value and neutral particle ratio,intraoperative bleeding volume,operation time,width and depth of LEEP conization) and postoperative indicators(postoperative bleeding stop time and the cervical length by ultrasound six months later after LEEP) of the two groups were compared.Results:Among 471 subjects,251(53.29%) had cervical stenosis or adhesion at the 6 th month after LEEP surgery.Among them,57(12.10%) had only cervical adhesion.There were 220(46.71%) cases without cervical stenosis and adhesion.There was no statistically significant difference between the two groups in average age,duration of menopause,pregnancy and delivery,preoperative white blood cell and neutrophil ratio,intraoperative blood loss,LEEP width,surgical indications and the cervical length six months later after LEEP(P>0.05).Among 471 subjects,the incidence of cervical stenosis and adhesion after LEEP was higher in those without vaginal delivery than those with vaginal delivery(81.58% vs 47.85%,P<0.05).The incidence of cervical stenosis and adhesion after LEEP surgery was higher in patients with LEEP surgery history than those without LEEP surgery history,and the difference was statistically significant(87.23% vs 49.53%,P<0.05).If the operation time was >5 minutes,the incidence of cervical stenosis and adhesion after operation was higher than that of those with the operation time ≤5 minutes,the difference was statistically significant(75.32% vs 48.98%,P<0.05).The incidence of cervical stenosis and adhesion after LEEP coning depth >15 mm was higher than that coning depth ≤15 mm,the difference was statistically significant(85.65% vs 20.51%,P<0.05).The incidence of cervical stenosis and adhesion after operation was higher in patients with bleeding drainage stopping time >4weeks than in patients with bleeding drainage stopping time ≤4weeks after operation(67.43% vs 41.11%,P<0.05).Conclusions:The clinical characteristics of cervical stenosis and adhesion after LEEP surgery in menopausal patients are no history of vaginal delivery,depth of LEEP conization,operation time,time to stop bleeding,drainage after LEEP surgery,and history of cervical LEEP surgery.When treating menopausal patients with LEEP surgery for cervical diseases,it is necessary to control the depth of surgery,avoid excessive burns in the cervical canal tissue,avoid extensive electrocoagulation for a long time to stop bleeding,strengthen hemostasis,prevent infection measures,and shorten the time of bleeding fluid after surgery to reduce cervical stenosis and adhesion.
Objective:To analyze the clinical characteristics of cervical stenosis and adhesion after loop electrosurgical excision procedure(LEEP) in menopausal patients.Methods:The clinical data of 471 menopausal patients undergoing LEEP surgery from January 2016 to December 2016 were analyzed retrospectively.Through colposcopy examination at the 6 th month after LEEP operation,471 menopausal patients were divided into two groups whether there were cervical stenosis and adhesion.The general indicators(age,menopause time,pregnancy history,vaginal delivery history,LEEP operation history),perioperative indicators(operation indication,preoperative white blood cell value and neutral particle ratio,intraoperative bleeding volume,operation time,width and depth of LEEP conization) and postoperative indicators(postoperative bleeding stop time and the cervical length by ultrasound six months later after LEEP) of the two groups were compared.Results:Among 471 subjects,251(53.29%) had cervical stenosis or adhesion at the 6 th month after LEEP surgery.Among them,57(12.10%) had only cervical adhesion.There were 220(46.71%) cases without cervical stenosis and adhesion.There was no statistically significant difference between the two groups in average age,duration of menopause,pregnancy and delivery,preoperative white blood cell and neutrophil ratio,intraoperative blood loss,LEEP width,surgical indications and the cervical length six months later after LEEP(P>0.05).Among 471 subjects,the incidence of cervical stenosis and adhesion after LEEP was higher in those without vaginal delivery than those with vaginal delivery(81.58% vs 47.85%,P<0.05).The incidence of cervical stenosis and adhesion after LEEP surgery was higher in patients with LEEP surgery history than those without LEEP surgery history,and the difference was statistically significant(87.23% vs 49.53%,P<0.05).If the operation time was >5 minutes,the incidence of cervical stenosis and adhesion after operation was higher than that of those with the operation time ≤5 minutes,the difference was statistically significant(75.32% vs 48.98%,P<0.05).The incidence of cervical stenosis and adhesion after LEEP coning depth >15 mm was higher than that coning depth ≤15 mm,the difference was statistically significant(85.65% vs 20.51%,P<0.05).The incidence of cervical stenosis and adhesion after operation was higher in patients with bleeding drainage stopping time >4weeks than in patients with bleeding drainage stopping time ≤4weeks after operation(67.43% vs 41.11%,P<0.05).Conclusions:The clinical characteristics of cervical stenosis and adhesion after LEEP surgery in menopausal patients are no history of vaginal delivery,depth of LEEP conization,operation time,time to stop bleeding,drainage after LEEP surgery,and history of cervical LEEP surgery.When treating menopausal patients with LEEP surgery for cervical diseases,it is necessary to control the depth of surgery,avoid excessive burns in the cervical canal tissue,avoid extensive electrocoagulation for a long time to stop bleeding,strengthen hemostasis,prevent infection measures,and shorten the time of bleeding fluid after surgery to reduce cervical stenosis and adhesion.
引文
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[18] Zhang H,Lu J,Lu Y,et al.Cervical microbiome is altered in cervical intraepithelial neoplasia after loop electrosurgical excision procedure in china[J].Sci Rep,2018,8(1):4923.
[19] Kietpeerakool C,Chumworathayi B,Thinkhamrop J,et al.Antibiotics for infection prevention after excision of the cervical transformation zone[J].Cochrane Database Syst Rev,2017,21(1):1-42.
[20] 边庆华,周月娟.阴道镜联合利普刀治疗子宫颈病变的可行性和安全性观察[J].当代医学,2017,23(36):159-160.
[21] Lee A,Kim TH,Lee HH,et al.Therapeutic approaches to atrophic vaginitis in postmenopausal women:a systematic review with a network meta-analysis of randomized controlled trials[J].J Menopausal Med,2018,24(1):1-10.
[22] Houlard S,Perrotin F,Fourquet F,et al.Risk factors for cervical stenosis after laser cone biopsy[J].Eur J Obstet Gynecol Reprod Biol,2002,104(2):144-147.
[2] Sopracordevole F,Clemente N,Alessandrini L,et al.Detection of occult endocervical glandular dysplasia in cervical conization specimens for squamous lesions[J].Pathol Res Pract,2017,213(3):210-216.
[3] Aluloski I,Tanturovski M,Petrusevska G,et al.Factors that influence surgical margin state in patients undergoing cold knife conization-a single center experience[J].Pril(Makedon Akad Nauk Umet Odd Med Nauki),2017,38(3):113-120.
[4] Rema P,Suchetha S,Thara S,et al.Effectiveness and safety of loop electrosurgical excision procedure in a low-resource setting[J].International Journal of Gynecology and Obstetrics,2008,103(2):105-110.
[5] Liverani CA,Di Giuseppe J,Clemente N,et al.Length but not transverse diameter of the excision specimen for high-grade cervical intraepithelial neoplasia(CIN 2-3)is a predictor of pregnancy outcome[J].Eur J Cancer Prev,2016,25(5):416-422.
[6] Tanaka Y,Ueda Y,Kakuda M.et al.Predictors for recurrent/persistent high-grade intraepithelial lesions and cervical stenosis after therapeutic conization:a retrospective analysis of 522 cases[J].Int J Clin Oncol,2017,22(5):921-926.
[7] Penna C,Fambrini M,Fallani MG,et al.Laser CO2 conization in postmenopausal age:risk of cervical stenosis and unsatisfactory follow-up[J].Gynecol Oncol,2005,96(3):771-775.
[8] Carcopino X,Mancini J,Gondry J,et al.Risk factors of inadequate colposcopy after large loop excision of the transformation zone:a prospective cohort study[J].J Low Genit Tract Dis,2018,22(1):31-37.
[9] Chen W,Zheng R,Zhang S,et al.Cancer incidence and mortality in China,2013[J].Cancer Lett,2017,401(10):63-71.
[10] 韩历丽,赵同香,邓小红.子宫颈癌筛查工作评价指标的比较研究[J/CD].中华妇幼临床医学杂志(电子版),2014,10(6):757-761.
[11] 林婧,吴丹,夏玮,等.子宫颈环形电切术导致的子宫颈黏连高危因素及预防措施[J/CD].中华妇幼临床医学杂志:电子版,2016,12(4):412-418.
[12] Boulanger JC,Gondry J,Verhoest P,et al.Treatment of CIN after menopause[J].Eur J Obstet Gynecol Reprod Biol,2001,95(2):175-180.
[13] Anttila A,Pukkala,S?derman B,et al.Effect of organised screening on cervical cancer incidence and mortality in Finland,1963-1995:recent increase in cervical cancer incidence[J].Int J Cancer,1999,83(1):59-65.
[14] Mathevet P,Chemali,Roy M,et al.Long-term outcome of a randomized study comparing three techniques of conization:cold knife,laser,and LEEP[J].Eur J Obstet Gynecol Reprod Biol,2003,106(2):214-218.
[15] Suh-Burgmann EJ,Whall-Strojwas D,Chang Y,et al.Risk factors for cervical stenosis after loop electrocautery excision procedure[J].Obstet Gynecol,2000,96(5 Pt 1):657-660.
[16] Baldauf JJ,Dreyfus M,Ritter J,et al.Risk of cervical stenosis after large loop excision or laser conization[J].Obstet Gynecol,1996,88(6):933-938.
[17] 林雪珊,周全,何春妮.子宫颈环形电切术并发症相关因素分析[J].中国临床医生杂志,2014,42,(3):56-57.
[18] Zhang H,Lu J,Lu Y,et al.Cervical microbiome is altered in cervical intraepithelial neoplasia after loop electrosurgical excision procedure in china[J].Sci Rep,2018,8(1):4923.
[19] Kietpeerakool C,Chumworathayi B,Thinkhamrop J,et al.Antibiotics for infection prevention after excision of the cervical transformation zone[J].Cochrane Database Syst Rev,2017,21(1):1-42.
[20] 边庆华,周月娟.阴道镜联合利普刀治疗子宫颈病变的可行性和安全性观察[J].当代医学,2017,23(36):159-160.
[21] Lee A,Kim TH,Lee HH,et al.Therapeutic approaches to atrophic vaginitis in postmenopausal women:a systematic review with a network meta-analysis of randomized controlled trials[J].J Menopausal Med,2018,24(1):1-10.
[22] Houlard S,Perrotin F,Fourquet F,et al.Risk factors for cervical stenosis after laser cone biopsy[J].Eur J Obstet Gynecol Reprod Biol,2002,104(2):144-147.