宫颈锥切术对生育能力及妊娠结局影响的研究进展

宫颈鳞状上皮内病变（squamous intraepithelial lesion,SIL）与宫颈癌的发生密切相关,近年来发病率逐渐升高且呈年轻化趋势,宫颈锥切术作为宫颈高级别鳞状上皮内病变（HSIL）患者的首选治疗方法被广泛应用。对于锥切术后有生育要求的患者,宫颈锥切术是否对妊娠产生影响目前尚不明确,现有的多数研究认为,宫颈锥切术不会显著影响生育能力,但可能增加早产、流产、胎膜早破和围生期死亡等不良妊娠结局的发生率,不会明显影响产程进展或增加剖宫产率;宫颈环形电刀锥切术（loop electrosurgical excisional procedure,LEEP）术后妊娠结局优于宫颈冷刀锥切术（cold-knife conization,CKC）,锥切术后应至少避孕6个月;锥切的深度和体积增加可增加不良妊娠结局的发生率;锥切术后患者不是必须行预防性宫颈环扎术。对于有生育要求的锥切术患者,应注意术后随诊,根据术中及术后恢复情况,个体化指导受孕,妊娠期严密监测宫颈长度及阴道感染情况,积极鼓励无阴道分娩禁忌患者行阴道试产。

Research Progress on the Effect of Cervical Conization on Fertility and Pregnancy Outcomes

Cervical squamous intraepithelial lesion (SIL) is closely related to the occurrence of cervical cancer. In recent years, the incidence of cervical SIL is gradually increasing and showing a younger trend. Cervical conization is widely used as the first choice for the treatment of cervical high-grade squamous intraepithelial(HSIL) patients. For patients with fertility requirements after conization, most existing studies believe that cervical conization does not affect their fertility, but may increase the incidence of adverse pregnancy outcomes such as preterm delivery, abortion, premature rupture of membranes and perinatal death, and will not significantly affect the progress of labor or increase the rate of cesarean section. The pregnancy outcome after LEEP is better than that of CKC, and contraception should be given at least 6 months after conization. The increase of depth and volume of conization can increase the incidence of adverse pregnancy outcome, and prophylactic cervical ligation is not necessary after conization. For patients with fertility requirements, we should pay attention to postoperative follow-up, individually guide pregnancy according to intraoperative and postoperative recovery, closely monitor cervical length and vaginal infection during pregnancy, and actively encourage patients without vaginal delivery contraindications to carry out vaginal trial delivery.