子宫颈上皮内瘤变患者子宫颈环形电切除术后妊娠结局及分娩方式的临床分析
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摘要
目的探讨子宫颈环形电切除术(LEEP)对子宫颈上皮内瘤变(CIN)患者术后妊娠分娩的影响。方法随访2013年1月至2015年12月在中国医科大学附属盛京医院妇科门诊因CIN行LEEP治疗且术后成功妊娠的患者,分析其自然流产率、早产率、低出生体质量率以及剖宫产率等。结果 35例患者术后成功妊娠,完成随访并获得妊娠结局30例,人工流产1例(3.3%),胚胎停育3例(10.0%),早产4例(13.3%),足月产22例(73.3%)。2例低出生体质量儿,新生儿均健康。已分娩的26例患者中,自然分娩11例(42.3%),剖宫产15例(57.7%)。早产率与锥切深度、锥切直径、手术次数及妊娠距手术的间隔时间均不相关(P>0.05)。结论LEEP对术后妊娠分娩影响较小,合理的切除范围不增加不良结局,术后3个月以上可考虑妊娠。LEEP锥切手术史不是剖宫产指征。
Objective To assess the effect of a loop electrosurgical excision procedure(LEEP) on subsequent pregnancy outcomes and the delivery mode in women diagnosed with cervical intraepithelial neoplasia(CIN). Methods A retrospective study was performed at Shengjing Hospital of China Medical University between January 2013 and December 2015. We studied women diagnosed with CIN who got pregnant after a LEEP. The rates of abortion,preterm births,low birth weight newborns,and cesarean sections performed were analyzed. Results Of the 35 women enrolled,data regarding follow-up pregnancy outcomes were available for only 30,One woman(3.3%) showed artificial abortion,3(10.0%) showed spontaneous abortion,4(13.3%) showed preterm labor,and 22(73.3%) showed full-term birth. All newborns were healthy,although 2 had low birth weight. Of the 26 women who had delivered,11(42.3%) underwent spontaneous labor and 15(57.7%) underwent a cesarean section,The risk of preterm labor was not associated with the depth of conization,diameter of LEEP,number of operations,and the time interval between the LEEP and the pregnancy(P > 0.05). Conclusion The effect of LEEP on obstetric outcomes is mild. Optimal surgery should be chosen based on the lesion. We propose that women can get pregnant 3 months after an LEEP and that a history of LEEP is not an indication to perform a cesarean section.
Objective To assess the effect of a loop electrosurgical excision procedure(LEEP) on subsequent pregnancy outcomes and the delivery mode in women diagnosed with cervical intraepithelial neoplasia(CIN). Methods A retrospective study was performed at Shengjing Hospital of China Medical University between January 2013 and December 2015. We studied women diagnosed with CIN who got pregnant after a LEEP. The rates of abortion,preterm births,low birth weight newborns,and cesarean sections performed were analyzed. Results Of the 35 women enrolled,data regarding follow-up pregnancy outcomes were available for only 30,One woman(3.3%) showed artificial abortion,3(10.0%) showed spontaneous abortion,4(13.3%) showed preterm labor,and 22(73.3%) showed full-term birth. All newborns were healthy,although 2 had low birth weight. Of the 26 women who had delivered,11(42.3%) underwent spontaneous labor and 15(57.7%) underwent a cesarean section,The risk of preterm labor was not associated with the depth of conization,diameter of LEEP,number of operations,and the time interval between the LEEP and the pregnancy(P > 0.05). Conclusion The effect of LEEP on obstetric outcomes is mild. Optimal surgery should be chosen based on the lesion. We propose that women can get pregnant 3 months after an LEEP and that a history of LEEP is not an indication to perform a cesarean section.
引文
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[3]罗岩,郭奇桑,隋龙,等.宫颈LEEP术对HSIL患者妊娠分娩方式及妊娠结局的影响[J].现代妇产科进展,2014,23(10):794-796.DOI:10.13283/j.cnki.xdfckjz.2014.10.010.
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[5]ACHARYA G,KJELDBERG I,HANSEN SM,et al.Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia[J].Arch Cynecol Obstet,2005,272(2):109-112.DOI:10.1007/s00404-005-0727-1.
[6]KALLIALA I,ANTTILA A,NIEMINEN P,et al.Pregnancy incidence and outcome before and after cervical intraepithelial neoplasia:a retrospective cohort study[J].Cancer Med,2014,3(6):1512-1516.DOI:10.1002/cam4.300.
[7]舒焰红,肖小敏,钱德英,等.宫颈电环切除术后妊娠结局的临床相关研究[J].现代妇产科进展,2012,21(10):768-770.DOI:10.13283/j.cnki.xdfckjz.2012.10.019.
[8]HIMES KP,SIMHAN HN.Time from cervical conization to pregnancy and preterm birth[J].Obstet Gynecol,2007,109(2Pt1):314-319.DOI:10.1097/01.AOG.0000251497.55065.74.
[9]KYRGIOU M,KOLIOPOULOS G,MARTIN-HIRSCH P,et al,Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions:systematic review and meta-analysis[J].Lancet,2006,367(9509):489-498.DOI:10.1016/S0140-6736(06)68181-6.
[2]KYRGIOU M,ATHANASIOU A,PARASKEVAIDI M,et al.Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth:systematic review and meta-analysis[J].BMJ,2016,354:i3633.DOI:10.1136/bmj.i3633.
[3]罗岩,郭奇桑,隋龙,等.宫颈LEEP术对HSIL患者妊娠分娩方式及妊娠结局的影响[J].现代妇产科进展,2014,23(10):794-796.DOI:10.13283/j.cnki.xdfckjz.2014.10.010.
[4]CONNER SN,FREY HA,CAHILL AG,et al.Loop electrosurgical excision procedure and risk of preterm birth:a systematic review and meta-analysis[J].Obstet Gynecol,2014,123(4):752-761.DOI:10.1097/AOG.0000000000000174.
[5]ACHARYA G,KJELDBERG I,HANSEN SM,et al.Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia[J].Arch Cynecol Obstet,2005,272(2):109-112.DOI:10.1007/s00404-005-0727-1.
[6]KALLIALA I,ANTTILA A,NIEMINEN P,et al.Pregnancy incidence and outcome before and after cervical intraepithelial neoplasia:a retrospective cohort study[J].Cancer Med,2014,3(6):1512-1516.DOI:10.1002/cam4.300.
[7]舒焰红,肖小敏,钱德英,等.宫颈电环切除术后妊娠结局的临床相关研究[J].现代妇产科进展,2012,21(10):768-770.DOI:10.13283/j.cnki.xdfckjz.2012.10.019.
[8]HIMES KP,SIMHAN HN.Time from cervical conization to pregnancy and preterm birth[J].Obstet Gynecol,2007,109(2Pt1):314-319.DOI:10.1097/01.AOG.0000251497.55065.74.
[9]KYRGIOU M,KOLIOPOULOS G,MARTIN-HIRSCH P,et al,Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions:systematic review and meta-analysis[J].Lancet,2006,367(9509):489-498.DOI:10.1016/S0140-6736(06)68181-6.