育龄期宫颈上皮内瘤变患者行宫颈环形电切除术对生育能力影响研究
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摘要
目的:探讨育龄期宫颈上皮内瘤变(CIN)患者行宫颈环形电切除术(LEEP)对生育能力的影响。方法:回顾性收集2016年2月—2018年2月北京大学医学部第一附属医院行LEEP且有生育要求的CIN患者160例为观察对象,同时选取同期就诊于本院有生育计划的健康妇女210例为对照组。对比两组的分娩方式、围生儿结局及妊娠结局。结果:观察组人为因素的剖宫产率及阴道分娩术助产率均高于对照组(P<0.05),两组流产率、非人为因素的剖宫产率无差异(P>0.05);观察组发生早产、胎膜早破、低出生体质量儿比例高于对照组,CIN Ⅲ级患者LEEP术后的流产率、早产率、胎膜早破率及低出生体质量儿率高于CIN Ⅰ级、Ⅱ级患者,术后至妊娠间隔时间<12个月患者流产率、早产率及阴道分娩助产率高于妊娠≥12个月(P<0.05);两组间剖宫产率及低出生体质量儿率未见差异(P>0.05)。结论:CIN患者行LEEP术并不影响分娩方式,但会增加早产、胎膜早破及低出生体质量儿的发生率。CIN级别越高患者更易产生不良妊娠结局。延长LEEP术后妊娠间隔,可降低CIN患者的流产率、早产率及阴道分娩助产率。
Objective:To explore the influence of LEEP on fertility and pregnancy outcomes of childbearing age women with cervical intraepithelial neoplasia(CIN).Methods:The data of 160 women who had experienced loop electrosurgical excision procedure(LEEP)because of CIN and had fertility requirements in first affiliated hospital of Peking university health science center from Feb.2016 to Feb.2018 were retrospective analyzed(in observation group).At that same period,another 210 healthy women with a birth plan in same hospital were selected into control group.Delivery mode,neonatal situation,and pregnancy outcomes were compared between the two groups.Results:The cesarean section rate caused by anthropogenic factors in observation group was significant higher than that in control group(P<0.05).There were no significant difference in abortion rate and the cesarean section rate without anthropogenic factors between the two groups(P >0.05).The incidences of premature delivery and premature rupture of membrane of women,and rate of lower weight newborn in observation group were significant higher than those of women in control group(P<0.05).The incidences of spontaneous abortion,premature rupture of membrane and rate of low weight of newborns of women with CIN Ⅲ were significant higher than those of women with CINⅡor CINⅠ(P<0.05).As for women with period less than12 months from accepted LEEP to pregnancy,abortion rate and preterm birth rate were significant higher than those of women with period equal to or more than 12 months(P<0.05).There were no significant different in rate of cesarean delivery and rate of low weight of newborns(P>0.05).Conclusion:LEEP treating patients with CIN has no any adverse impact on late delivery way of patients,but maybe increase the incidence of premature,rupture of membrane,and low weight of newborns.Patients with CIN Ⅲ have higher adverse pregnant outcomes when comparing that of patients with CIN Ⅰ and CIN Ⅱ.If patients have Longer time from accepted LEEP to pregnancy,the rates of spontaneous abortion and premature could decrease.
Objective:To explore the influence of LEEP on fertility and pregnancy outcomes of childbearing age women with cervical intraepithelial neoplasia(CIN).Methods:The data of 160 women who had experienced loop electrosurgical excision procedure(LEEP)because of CIN and had fertility requirements in first affiliated hospital of Peking university health science center from Feb.2016 to Feb.2018 were retrospective analyzed(in observation group).At that same period,another 210 healthy women with a birth plan in same hospital were selected into control group.Delivery mode,neonatal situation,and pregnancy outcomes were compared between the two groups.Results:The cesarean section rate caused by anthropogenic factors in observation group was significant higher than that in control group(P<0.05).There were no significant difference in abortion rate and the cesarean section rate without anthropogenic factors between the two groups(P >0.05).The incidences of premature delivery and premature rupture of membrane of women,and rate of lower weight newborn in observation group were significant higher than those of women in control group(P<0.05).The incidences of spontaneous abortion,premature rupture of membrane and rate of low weight of newborns of women with CIN Ⅲ were significant higher than those of women with CINⅡor CINⅠ(P<0.05).As for women with period less than12 months from accepted LEEP to pregnancy,abortion rate and preterm birth rate were significant higher than those of women with period equal to or more than 12 months(P<0.05).There were no significant different in rate of cesarean delivery and rate of low weight of newborns(P>0.05).Conclusion:LEEP treating patients with CIN has no any adverse impact on late delivery way of patients,but maybe increase the incidence of premature,rupture of membrane,and low weight of newborns.Patients with CIN Ⅲ have higher adverse pregnant outcomes when comparing that of patients with CIN Ⅰ and CIN Ⅱ.If patients have Longer time from accepted LEEP to pregnancy,the rates of spontaneous abortion and premature could decrease.
引文
[1]巴哈尔古丽·依斯巴依力,魏玮.宫颈环形电切除术治疗宫颈上皮内瘤变的疗效分析[J].临床医药文献电子杂志,2017,4(12):2232-2234.
[2]Massad LS,Einstein MH,Huh WK,et al.2012updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors[J].Obstet Gynecol,2013,121(4):829-846.
[3]李湖英.宫颈环形电切除术联合干扰素治疗宫颈上皮内瘤变的临床研究[J].中外医疗,2016,35(14):150-151.
[4]钱菊芬,陶爱群.宫颈环形电切术与冷刀锥切术治疗宫颈上皮内瘤变疗效比较[J].中国计划生育学杂志,2013,21(4):263-265.
[5]刘虹岚.宫颈冷刀锥切术与宫颈环行电切除术治疗宫颈上皮内瘤变Ⅲ级的临床疗效比较[J].现代诊断与治疗,2016,27(2):356-357.
[6]Spracklen CN,Harland KK,Stegmann BJ,et al.Cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth:a case-control study[J].BJOG,2013,120(8):960-965.
[7]谭艳萍.宫颈环形电切除术治疗不同级别宫颈上皮内瘤变的效果及其对预后的影响[J].中国肿瘤临床与康复,2014,21(6):727-729.
[8]Kyrgiou M,Koliopoulos G,Martin-Hirsch P,et al.Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions:systematic review and metaanalysis[J].Lancet,2006,367(959):489-498.
[9]吴丽丽,黄莉.宫颈电环切术治疗宫颈上皮内瘤变的疗效及对妊娠结局的影响[J].中国基层医药,2013,20(11):3229-3231.
[10]Frega A,Sesti F,De Sanctis L,et al.Pregnancy outcome after loop electrosurgical excision procedure for cervical intraepithelial neoplasia[J].Int J Gynaecol Obstet,2013,122(2):145-149.
[11]钱菊芬,陶爱群.宫颈环形电切术与冷刀锥切术治疗宫颈上皮内瘤变疗效比较[J].中国计划生育学杂志,2013,21(4):263-265.
[12]Castanon A,Brocklehurst P,Evans H,et al.Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England:retrospectiveprospective cohort study[J].BMJ,2012,345:e5174
[13]Conner SN,Cahill AG,Tuuli MG,et al.Interval from loop electrosurgical excision procedure to pregnancy and pregnancy outcomes[J].Obstet Gynecol,2013,122(6):1154-1159.
[14]谢洁玲,蔡叶萍.宫颈上皮内瘤变宫颈环形电切除术后对育龄妇女生育的影响[J].中国计划生育和妇产科,2017,9(5):40-43.
[2]Massad LS,Einstein MH,Huh WK,et al.2012updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors[J].Obstet Gynecol,2013,121(4):829-846.
[3]李湖英.宫颈环形电切除术联合干扰素治疗宫颈上皮内瘤变的临床研究[J].中外医疗,2016,35(14):150-151.
[4]钱菊芬,陶爱群.宫颈环形电切术与冷刀锥切术治疗宫颈上皮内瘤变疗效比较[J].中国计划生育学杂志,2013,21(4):263-265.
[5]刘虹岚.宫颈冷刀锥切术与宫颈环行电切除术治疗宫颈上皮内瘤变Ⅲ级的临床疗效比较[J].现代诊断与治疗,2016,27(2):356-357.
[6]Spracklen CN,Harland KK,Stegmann BJ,et al.Cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth:a case-control study[J].BJOG,2013,120(8):960-965.
[7]谭艳萍.宫颈环形电切除术治疗不同级别宫颈上皮内瘤变的效果及其对预后的影响[J].中国肿瘤临床与康复,2014,21(6):727-729.
[8]Kyrgiou M,Koliopoulos G,Martin-Hirsch P,et al.Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions:systematic review and metaanalysis[J].Lancet,2006,367(959):489-498.
[9]吴丽丽,黄莉.宫颈电环切术治疗宫颈上皮内瘤变的疗效及对妊娠结局的影响[J].中国基层医药,2013,20(11):3229-3231.
[10]Frega A,Sesti F,De Sanctis L,et al.Pregnancy outcome after loop electrosurgical excision procedure for cervical intraepithelial neoplasia[J].Int J Gynaecol Obstet,2013,122(2):145-149.
[11]钱菊芬,陶爱群.宫颈环形电切术与冷刀锥切术治疗宫颈上皮内瘤变疗效比较[J].中国计划生育学杂志,2013,21(4):263-265.
[12]Castanon A,Brocklehurst P,Evans H,et al.Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England:retrospectiveprospective cohort study[J].BMJ,2012,345:e5174
[13]Conner SN,Cahill AG,Tuuli MG,et al.Interval from loop electrosurgical excision procedure to pregnancy and pregnancy outcomes[J].Obstet Gynecol,2013,122(6):1154-1159.
[14]谢洁玲,蔡叶萍.宫颈上皮内瘤变宫颈环形电切除术后对育龄妇女生育的影响[J].中国计划生育和妇产科,2017,9(5):40-43.