宫颈锥切术对未来妊娠结局的影响

目前宫颈锥切术是否增加未来不良妊娠结局的风险,尚存争议。宫颈锥切术对患者的生育能力无显著影响,但可能增加未来早产、低出生体重、胎膜早破及围产期死亡的风险。宫颈锥切术的术式、切除范围和手术至妊娠的时间是影响不良妊娠结局的重要因素。宫颈锥切术可引起宫颈狭窄及宫颈机能不全,应用超声监测宫颈长度有助于预测早产。目前尚无证据表明,宫颈锥切术增加剖宫产率。     

宫颈冷刀锥切术对生育能力及妊娠结局的影响

目的:探讨宫颈冷刀锥切术对患者生育能力的影响及是否产生不良妊娠结局。方法:收集1998年10月至2008年9月收治的因宫颈上皮内瘤变(CIN)或宫颈原位癌于我院实施宫颈冷刀锥切术且有生育要求的患者96例作为观察组,随机抽取同期孕前门诊的100例无宫颈锥切术史的妇女作为对照组。对两组对象的生育能力、妊娠结局及围生儿情况进行分析。结果:①观察组术后妊娠率(89.6%)与对照组(91.0%)相比,差异无统计学意义(P>0.05)。②观察组剖宫产率(34.7%)高于对照组(20.5%)(P<0.05),两组流产率、阴道试产成功率、产钳助产率、平均产程及各项剖宫产指征比较差异均无统计学意义(P>0.05)。③观察组严重早产发生率(8.0%)和早产胎膜早破发生率(10.7%)高于对照组(1.2%和2.4%)(P<0.05),而观察组新生儿出生体重低于对照组(P<0.05);观察组早产及小于胎龄儿发生率与对照组比较差异无统计学意义(P>0.05);④宫颈锥切术距术后初次妊娠时间间隔<6月组、6～12月组及≥12月组的不良妊娠结局比较,3组差异均无统计学意义(P>0.05);⑤将锥切高度<10mm、10～20mm及≥20mm分成3组,流产率、早产率、早产胎膜早破及小于胎龄儿发生率随宫颈锥切的高度递增,但差异无统计学意义(P>0.05)。结论:宫颈锥切术后对患者妊娠能力无明显影响,但可增加不良围生结局发生率;宫颈锥切术距术后妊娠的时间间隔和锥切高度与不良围生结局无明显关系。     

宫颈锥切术后妊娠60例临床分析

目的：探讨宫颈锥切术是否影响生育能力。方法：从2009年1月一2010年1 月随访全年门诊宫颈锥切术后6O例妊娠病例,进行回顾性分析。 结果：有15例病人在孕中期发生自然流产,有5例病人足月顺产,10例病人因计划外怀孕, 宫口不开,行钳刮术。余3O例病人均做剖宫产。结论：可见宫颈锥切术能明显增加流产和 剖宫产的几率。     

宫颈锥切术对足月妊娠初产妇产程影响分析

Objective?To analyze the impact of cervical conization on each labor stage of nulliparity with term pregnancy. Methods?76 cases of full-term nulliparitis with a history of cervical conization were enrolled as the observation group. 155 cases of healthy full-term nulliparitis were enrolled as the control group randomly. Medical records of two groups were established in Beijing Obstetrics and Gynecology Hospital during May 2016 to April 2018. The duration of each labor stage were compared and their relationship between cervical conization were analyzed. Results?①The duration of the first, third stage of labor and total stage of labor were all significant shorter in the observation group who were＜35 years old (n=58) than the control group(n=137), (P=0.024, 0.018, 0.034). While the second stage of labor was longer than the control group, with no significant difference (P＞0.05). ② The duration of the first, second, third stage of labor and the total stage of labor in experiment group who were ≥35 years old (n=18) were longer than the control group (n=18), but the differences were not significant (P＞0.05). ③ The duration of the first, third stage of labor and total stage of labor were shorter in the observation group (n=58) than the control group (n=137). The second stage of labor was longer than the control group, but the differences were not significant (P＞0.05). ④ There were no significant correlation between cervical conization and each stage of labor (P＞0.05). And cervical conization were not independent factor of each stage of labor (P＞0.05). Conclusions?Cervical conization can shorten labor duration on those who are＜35 years old, and has no effect on those who are  old. Cervical conization was not independent factor of each labor stage.     

宫颈锥切术对足月妊娠初产妇产程影响分析CSCD

目的 观察宫颈锥切术对足月妊娠初产妇各产程的影响,并分析锥切术与各产程之间的关系。方法选择2016年5月至2018年4月于北京妇产医院建档且有宫颈锥切术史的足月妊娠初产妇(n=76)为观察组,随机选择同期无宫颈锥切术史的足月妊娠初产妇(n=155)为对照组。通过回顾性研究,比较两组产妇各产程时间的长短,并通过逻辑回归分析锥切术与各产程时间长短的相关性。结果 (1)观察组<35岁产妇(n=58)的第一、三产程及总产程均显著短于对照组(n=137),且两组相比差异均有统计学意义(P=0.024, 0.018,0.034),而第二产程长于对照组,差异无统计学意义(P> 0.05);(2)观察组≥35岁产妇(n=18)的第一、二、三产程及总产程均长于对照组(n=18),差异均无统计学意义(P>0.05);(3)观察组全部产妇(n=76)的第一、三产程及总产程均短于对照组(n=155),第二产程长于对照组,差异均无统计学意义(P>0.05);(4)宫颈锥切术与各产程均无明显相关性(P>0.05),也不是各产程的独立影响因素(P>0.05)。结论 对于<35岁的产妇,宫颈锥切术可缩短产程;对于≥35岁的产妇,宫颈锥切术不影响产程进展。宫颈锥切术与各产程均无明显相关性,也不是各产程的独立影响因素。     

宫颈病变锥切术后妊娠8例分析

近年来，宫颈病变的发病越来越年轻化，宫颈锥切术也较多地用于宫颈病变的治疗，使得年轻患者的生育功能得以保留。临床上，值得引起重视的是宫颈锥切术后妊娠期和分娩期的管理问题，如果处理不当，可造成不良妊娠结局。中国医科大学附属盛京医院妇产科报道了8例因宫颈病变行锥切术后妊娠及其结局，虽然病例数不多，但临床观察资料较完整，能够初步说明宫颈锥切术后妊娠，容易并发阴道炎症、宫颈机能不全、流产和早产等。因此，应高度重视宫颈锥切术后妊娠的管理，注意阴道炎的防治，适时行宫颈环扎术，避免不必要的流产和早产，可改善妊娠结局。对于早期宫颈癌（Ia期），尤其是Ia1期的年轻患者，也可行锥切术治疗，但术后可以妊娠的时间，以及分娩后随访等问题，尚有待进一步研究。[编者按]     

宫颈锥切术的适应证及并发症

子宫颈上皮内瘤样病变(CIN)患者日渐年轻化，使治疗趋向保守，子宫颈锥形切除术是保留生育功能的治疗方法而被广泛应用。目前主要有冷刀子宫颈锥形切除术(cold knife conization)、激光锥切术（laser conization)、子宫颈电热圈环切术(loop electrical excision procedure，LEEP)和超声锥切术(harmonic scalpel cone)。     

宫颈电环切术对妊娠时限及分娩方式的影响

目的:探讨宫颈上皮内瘤变患者行宫颈电环切术对妊娠时限、分娩方式及新生儿情况的影响.方法:选择因宫颈上皮内瘤变而行宫颈电环切术,于术后妊娠并分娩的32例产妇为研究组,同时取同期分娩且孕前未行任何宫颈手术的产妇64例为对照组,观察两组间的妊娠时限、分娩方式及新生儿出生体重等指标的差异.结果:两组资料可比性强.研究组早产3例,剖宫产16例,2例新生儿出生体重＜2500 g.对照组早产7例,剖宫产30例,6例新生儿出生体重＜2500g.两组间早产率、剖宫产率、低出生体重儿率差异均无显著性(P＞0.05).结论:宫颈电环切术是治疗宫颈上皮内瘤变安全有效的方法,不会增加随后妊娠的剖宫产率、早产率和低出生体重儿率.     

宫颈冷刀锥切术和宫腔镜下宫颈锥切术治疗高级别宫颈上皮内瘤变的疗效分析

目的:比较宫颈冷刀锥切术(CKC)和宫腔镜下宫颈锥切术(TCRC)对于宫颈上皮内瘤变(CIN)Ⅱ、Ⅲ的临床疗效。方法:选取2010年1月1日至2014年6月1日就诊于南方医科大学珠江医院,手术、病理及随访资料完整的CINⅡ、Ⅲ患者共176例,其中CKC组62例,TCRC组114例。比较两组患者年龄、孕产次数及术前病理分级并评估手术时间、术中出血量、术后阴道流血及病理切缘阳性和术后宫颈狭窄、复发等情况。结果:两组患者年龄、孕产次数及术前CIN分级差异均无统计学意义(P0.05)。CKC组术中平均出血量(14.16±14.10 ml)、平均住院时间(5.73±1.43天)与TCRC组(29.80±20.55 ml,4.75±1.23天)比较差异有统计学意义(P0.05)。CKC组平均手术时间(33.15±11.42分钟)、术后阴道流血率(33.9%)、病理切缘阳性率(3.2%)、宫颈狭窄率(4.8%)、复发率(4.8%)与TCRC组(分别为33.18±14.61分钟、21.1%、5.3%、4.4%、3.5%)比较差异无统计学意义(P0.05)。CKC组术前宫颈活检病理和术后病理结果一致率为74.2%(46/62),TCRC组为72.8%(83/114),kappa值0.75。结论:两种方法用于治疗高级别宫颈上皮内瘤变均安全有效。与CKC相比,TCRC可减少患者住院时间,但可能增加术中出血量,需在手术中注意。     

妊娠合并宫颈病变分娩时机及方式的选择

妊娠合并宫颈病变主要指妊娠合并宫颈上皮内瘤变(CIN)及宫颈浸润癌。妊娠合并CIN患者可以妊娠至足月,经阴道分娩;妊娠合并宫颈癌的处理(分娩时机及分娩方式)依赖于宫颈癌分期、淋巴结有无转移、肿瘤的组织学分型、孕周及患者是否希望继续妊娠。     

Cervical conization and the risk of preterm delivery

The current body of literature concerning cervical conization and its effect on subsequent pregnancy outcome is conflicting. Depending on the type of conization procedure that is examined and the quality of the control group, the results and conclusions vary widely. Because treatment for cervical intraepithelial neoplasia is commonplace among women of reproductive age, it is imperative that practitioners have an understanding of the issues surrounding the treatment. Therefore, this review will summarize the published literature that addresses excisional procedures of the uterine cervix and the risk of preterm delivery in subsequent pregnancies and provide reasonable treatment recommendations for women with cervical abnormalities and a desire for future fertility.     

The effect of cervical cerclage on pregnancy outcomes in women following conization

Abstract

Objectives: To determine the effect of cervical cerclage on obstetrical complications and perinatal outcomes of patients following conization.

Design: A retrospective population based cohort study.

Setting: Tertiary academic medical center that covers all the deliveries of the region.

Population: All patients with previous cervical conization who delivered between the years 1994–2011.

Methods: A retrospective population based study.

Main outcome measures: The effect of cerclage placement on the rate of preterm birth.

Results: During the study period there were 109 deliveries of patients following a cervical conization. Cervical cerclage was placed in 22 deliveries that served as the study group and the rest (n?=?87) served as the comparison group. The rate of early preterm delivery (PTD; <34 weeks) was significantly higher in women who had a cerclage. In a logistic regression model, cerclage was found to be an independent risk factor for early PTD.

Conclusion: Cerclage is an independent risk factor for early PTD In patients who had a conization due to CIN.     

Large loop conization for early invasive cervical cancer

The objective of this prospective study was to manage microinvasive cervical cancer (FIGO stage IA) using large loop conization. Cytologic, colposcopic, and histologic findings in women with microinvasion who were managed with large loop conization during 1990–94, are presented together with fertility and pregnancy outcome. A histologic diagnosis of microinvasion was made following large loop conization in 42 women. Histopathology showed a depth of invasion less than 3 mm in 35 cases. In the absence of lymphvascular space involvement, conservative management by means of intensive cytologic and colposcopic surveillance, was adopted in 29 women. The mean age of these women was 30.6 (±3.5) years (range 24–36 years of age) and all women completed at least 25 months of follow-up. During the study period 19 women became pregnant. It was concluded that large loop conization can be an alter-native method of treatment in cervical microinvasive cancer with depth of invasion less than 3 mm and no lymphvascular space involvement, especially in young women who wish future fertility.     

宫颈锥切术在诊断宫颈上皮内瘤样病变和早期宫颈癌中的价值

目的探讨宫颈锥切术能否被阴道镜多点活检所代替以及宫颈锥切术在诊断宫颈上皮内瘤样病变（CIN）和早期宫颈癌中的价值。方法回顾分析近5年来,在江苏大学附属宜兴医院妇产科因宫颈病变同时行阴道镜多点活检和宫颈锥切术（包括冷刀和电圈环切术即LEEP术）的患者120例,采用自身对照法,对比研究宫颈锥切术和阴道镜多点活检的病检结果的差异。结果宫颈锥切术与阴道镜下多点活检病理符合者59例（49．17％）;不符合者61例（50．83％）,宫颈锥切术后病理诊断加重者35例（占29．17％）,浸润癌漏诊率达10．00％。宫颈锥切术的主要并发症为出血。结论宫颈锥切术在诊断CIN和早期宫颈癌具有重要价值,不能被阴道镜多点活检所取代。要重视切缘是否阳性和加强术后的随访。     

宫颈锥切术后妊娠结局临床分析

目的探讨宫颈锥切术对妊娠结局的影响。方法锥切组为2007年9月1日至2011年8月31日期间在北京海淀区妇幼保健院住院分娩的共82例妊娠前曾因宫颈上皮内瘤样病变行宫颈锥切术(手术方式包括冷刀锥切术和环形电刀锥切术)的患者,随机选择同期480例未行宫颈锥切术的患者为对照组,比较两组患者的分娩方式、妊娠并发症等。结果 (1)锥切组剖宫产率59.76%(49/82),产钳助产率15.85%(13/82),明显高于对照组,自然分娩率24.39%(20/82),明显低于对照组,差异有统计学意义(P﹤0.01);如果去除剖宫产指征为社会因素的患者,锥切组剖宫产率31.71%(26/82),对照组剖宫产率29.58%(142/480),两组比较差异无统计学意义(P﹥0.05)。(2)锥切组早产发生率19.51%(16/82),胎儿窘迫发生率18.29%(15/82),明显高于对照组,差异有统计学意义(P﹤0.01);胎膜早破发生率23.17%(19/82),与对照组比较,差异有统计学意义(P﹤0.05)。软产道裂伤0例,低出生体重儿8.54%(7/82),与对照组比较,差异无统计学意义(P﹥0.05)。(3)宫颈锥切术与妊娠间隔时间≤1年早产的发生率8.6%(3/35),间隔时间﹥1年早产的发生率27.7%(13/47),后者高于前者,差异有统计学意义(P﹤0.05)。结论宫颈锥切术将会影响继之的妊娠结局,增加早产、胎膜早破等的发生率。如果去除社会因素,并没有增加剖宫产率。     

Development of endometrioma after cervical conization

The association between cervical conization and subsequent development of endometriosis is uncertain. The objective of this study was to estimate the incidence rate of ovarian endometrioma after cervical conization and to determine factors associated with the development of endometrioma. One hundred forty-two patients who underwent cervical conization at the University of Tokyo Hospital between January 2006 and December 2013 were included in the study. Their medical records were retrospectively studied until April 2015. The incidence rate of postconization endometrioma was calculated. Patients’ characteristics (age, parity, preoperative and postoperative diagnosis and observation period) were analyzed. Six patients developed endometrioma after the cervical conization, and the incidence rate of endometrioma among patients who underwent cervical conization was 10.8 per 1000 person-year (95%CI 3.6–20.5). Patients’ age, percent of nulliparous, postoperative diagnosis and observation period were not associated with the development of postconization endometrioma. A preoperative diagnosis with invasive cancer (p?相似文献   

Prediction of disease persistence after conization for microinvasive cervical carcinoma and cervical intraepithelial neoplasia grade 3

We attempted to determine the significant variables and to predict the probability of disease persistence after conization for microinvasive cervical carcinoma and cervical intraepithelial neoplasia grade 3 (CIN3). We analyzed 133 patients from 2001 to 2002 who had a subsequent hysterectomy after conization. The histological findings of the cone specimens, together with the clinical parameters, were correlated with the presence of residual dysplasia in the hysterectomy specimen. The probability of having residual dysplasia was calculated based on the function of the significant variables obtained by logistic regression analysis. Of the 133 patients, 42 (31.6%) had residual disease in their hysterectomy specimens. Using multivariate analysis only for the postmenopausal state, positive endocervical curettage, positive margin, and microinvasive carcinoma were predictive of residual dysplasia. The probabilities of having residual dysplasia were about 0.99, 0.84, 0.4, 0.07, and 0.01 in patients with a presence of all four, any three, any two, any one, and no risk factors, respectively. The best cutoff probability determined by the receiver operating characteristic curve was 0.32, yielding a sensitivity of 81% and a specificity of 88%. Based on these results, patients with the presence of any two or more of the risk factors mentioned above should be considered as a high-risk group for having disease persistence after conization for the treatment of CIN3 and microinvasive carcinoma.     

双胎妊娠的分娩方式与妊娠结局探讨

目的　探讨双胎妊娠的分娩方式与妊娠结局的关系。方法　将 1995年 1月至 2 0 0 3年 5月 98例双胎妊娠产妇按分娩方式分为阴道分娩组及剖宫产组 ,对其临床资料进行回顾性分析。结果　两组的孕周、产后出血率比较差异无显著性意义 (P >0 0 5 ) ,剖宫产组新生儿体重显著高于阴道分娩组 (P <0 0 1) ,两组第 1胎分娩新生儿窒息率差异无显著性意义 (P >0 0 5 ) ,而第 2胎分娩新生儿窒息率剖宫产组显著低于阴道分娩组(P <0 0 5 )。结论　正确选择双胎妊娠的分娩方式 ,将有助于降低剖宫产率及新生儿窒息率