LEEP术治疗宫颈上皮内瘤变对妊娠母儿相关结局影响的Meta分析

目的：探讨宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）行宫颈环形电切术（loop electrosurgical excision procedure，LEEP）治疗对妊娠母儿相关结局的影响。方法：检索PubMed、Cochrane Library、CNKI、CBM、万方、维普等电子数据库发表的有关CIN行LEEP治疗对妊娠母儿结局影响的病例对照研究，采用Revman 5.3软件进行统计分析。结果：共纳入40篇病例对照研究，共9 002例病例，其中病例组4 196例、对照组4 806例。Meta分析结果显示，与对照组比较，CIN患者LEEP术后妊娠情况如下。（1）妊娠早、中期相关结局：流产（RR=1.34，９5%CI：1.14～1.57，P＜0.05）风险增加，而受孕率、引产率及异位妊娠率差异无统计学意义（均P＞0.05）；（2）妊娠晚期相关结局：① 孕产妇方面，早产（RR=1.60，95%CI：1.37～1.86，P＜0.05）、未足月胎膜早破（RR=2.72，95%CI：1.46～5.07，P＜0.05）风险明显增加，而胎膜早破、剖宫产、前置胎盘及产后出血的发生率差异无统计学意义（均P＞0.05）；② 围生儿方面，低出生体质量儿发生率（RR=1.35，95%CI：1.10～1.66，P＜0.05）增加，而胎儿窘迫、新生儿窒息及新生儿病死率差异无统计学意义（均P＞0.05）；③分娩方式及其并发症方面，LEEP术不增加急产、产钳与胎头吸引助产及宫颈裂伤的风险（均P＞0.05）。结论：LEEP术增加流产、早产、未足月胎膜早破及低出生体质量儿发生的风险。对于有生育要求的CIN患者，LEEP术前应充分告知妊娠不良结局的风险。

Pregnancy Outcomes Following Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia:A Meta-Analysis

Objective:To analyze the association of the treatment safety and the related pregnancy outcomes with previous treatment of the loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia(CIN). Methods:A thorough search of PubMed, Cochrane Library, CNKI, CBM, Wanfang and CqVip electronic databases was performed. Case-control studies about pregnancy outcomes after previous treatment of LEEP for CIN were collected and meta-analysis was carried out with RevMan 5.3 software. Results:Forty case-control studies including 9002 patients were enrolled in this study with 4196 patients in study group and 4806 patients in control group. For women with previous LEEP for CIN, meta-analysis revealed that: (1)The incidence of miscarriage was significantly increased in study group as compared with that of control group (RR=1.34, 95%CI:1.14-1.57, P<0.05), no significant difference was found in the incidence of pregnancy, ectopic pregnancy and induced labor with respect to the first, mid trimester of pregnancy between study group and control group (P>0.05 each);(2)①For maternal, LEEP was associated with a higher risk of preterm delivery (RR=1.60, 95%CI:1.37-1.86, P<0.05), preterm premature rupture of membranes (RR=2.72, 95%CI:1.46-5.07, P<0.05), no significant difference was found in the incidence of premature rupture of membranes, cesarean section, placenta previa, postpartum hemorrhage in regard to the perinatal period (the late trimester of pregnancy) between study group and control group(P>0.05 each);②For perinatal infants, the incidence of low birth weight was obviously increased in study group (RR=1.35, 95%CI:1.10-1.66, P<0.05), no significant difference was found in the incidence of fetal distress, neonatal asphyxia and neonatal mortality during perinatal period between study group and control group (P>0.05 each);③For delivery way and complications, LEEP was not associated with a significantly increased risk of precipitate labour, forceps delivery and vacuum extraction delivery, and cervical laceration (P>0.05 each). Conclusions:LEEP is associated with an increased risk of miscarriage, preterm delivery, preterm premature rupture of membranes and low birth weight. For CIN patients with fertility preservation, the risk of adverse pregnancy outcomes should be fully informed before LEEP.