宫颈电环锥切术和冷刀锥切术对妊娠影响的对照分析_临床医学论文.docVIP

宫颈电环锥切术和冷刀锥切术对妊娠影响的对照分析_临床医学论文 宫颈电环锥切术和冷刀锥切术对妊娠影响的对照分析_临床医学论文 【摘要】 目的探讨宫颈LEEP(Loop electrosurgical excision procedure, LEEP)和CKC(cold knife conization)术对术后妊娠结局的影响。方法选择2005年1月—2009 年1月在本院行LEEP或CKC手术并有生育要求的宫颈上皮内瘤变患者为研究对象,同时取同期行阴道镜检查，但未行任何宫颈治疗，并有生育要求的患者为对照组,观察三组间妊娠妇女妊娠结局的差异。治疗组与对照组在年龄、产次及可导致早产的产科合并症方面具有可比性。结果 CKC组早产率(14/36,38.88%)高于对照组(14/68,20.59%)(P=0.048)，风险比为2.455(1.007~5.985)，LEEP组(10/48,20.83%)同对照组相比差异无显著性，早产与锥切的深度密切相关，锥切深度大于15mm后早产风险比明显升高;CKC组平均孕周(36.9±2.4)低于对照组(37.8±2.6)(P=0.049)，LEEP组(38.1±2.4)同对照组相比，差异无显著性;三组剖宫产率差异无显著性;CKC组体重小于2500g的新生儿比率(15/36)明显多于对照组(10/68)(P=0.005)，LEEP组(9/48)无明显增多。结论CKC对术后妊娠结局有一定负面影响，而LEEP术相对安全。LEEP术可以作为生育要求CIN患者优先考虑的治疗手段。 【关键词】 宫颈锥切术;宫颈电环锥切术;冷刀锥切;宫颈上皮内瘤变;妊娠结局 　　[Abstract]ObjectiveTo examine the consequences of cervical conisation in terms of adverse outcome in subsequent pregnancies. MethodsFrom 2005 January to 2009 January, patients with request of pregnancy, who received LEEP or CKC surgery at our hospital because of CIN lesions were chosen as the study subjects. Women , also with request of pregnancy, who only received colposcopic biopsy and no any other cervical surgery at the same time were appointed to the control group. The subsequent pregnancy outcomes including preterm, mean gestational weeks, mode of delivery, low neonatal birth weight were compared between LEEP or CKC group and the control group. Logistic regression analyses were used to evaluate association between cone characteristics and the subsequent risk of preterm delivery. The three groups were similar in age , gravidity and obstetric complications relevant to preterm pregnancy.ResultsThe proportion of preterm delivery was significantly higher in CKC group(14/36,38.88%) than the control group (14/68,20.59%)(P=0.048) and the odds risk increased to 2.455 (1.007~5.985).While preterm rate in LEEP group (10/48,20.83%) had no difference compared with the control group. The occurrence of preterm pregnancy was associated with cone depth. Increasing cone depth was associated w