宫颈环形电切术和冷刀锥切术对妊娠影响的比较

目的探讨宫颈环形电切术（LEEP）和宫颈冷刀锥切术（CKC）对宫颈病变术后妊娠结局的影响。方法选择2010年2月—2011年12月期间在医院行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,同期随机选取在我院就诊有生育要求的健康妇女作为对照组,比较3组间妊娠结局。结果 LEEP组中平均孕周略短（37.9±1.6）周,胎膜早破发生率（12.2%）、早产率（20.4%）、新生儿低体重出生率（16.3%）,与对照组平均孕周（38.1±1.7）周、胎膜早破发生率（11.7%）、早产率（18.3%）、新生儿低体重出生率（13.3%）相比较,差异均无统计学意义（P〉0.05）;CKC组中,平均孕周较短（36.7±2.0）周,胎膜早破发生率（29.3%）、宫颈裂伤发生率（14.6%）及早产率（41.5%）均明显高于对照组,低体重儿相对较多（发生率29.3%）,差异均有统计学意义（P〈0.05）。结论宫颈冷刀锥切显著增加早产的风险,宫颈环形电切术相对危险度较低,术后妊娠相对安全,对妊娠结局无明显影响。因此在对有生育要求CIN女性患者,LEEP可作为优先考虑的治疗方案。

A comparison of pregnancy outcomes of patients with cervical lesion after loop electrosurgical excision procedure and cold knife conization

Objective To observe the pregnancy outcomes after loop electrosurgical excision procedure（LEEP） or cold knife conization（ CKC） in patients with cervical lesions. Methods The patients with cervical intraepithelial neoplasia（CIN） in our hospital from Feb.2010 to Dec.2011 were selected for LEEP or CKC,and healthy outpatient women were randomly selected as control. The pregnancy outcomes were compared among the three groups. Results There was no statistical difference in the average gestational age（37. 9 ± 1. 6 vs. 38. 1 ± 1. 7 weeks）,incidence of premature rupture of membranes（12. 2% vs. 11. 7%）,preterm birth rate（20. 4% vs. 18. 3%）,low birth weight rate of newborn（16. 3% vs.13. 3%） between the LEEP group and control group（P〉0. 05）;but there was significant difference in the average gestational age（36. 7 ± 2. 0 vs. 38. 1 ± 1. 7 weeks）,incidence of premature rupture of membranes（29. 3% vs. 11. 7%）,preterm birth rate（41. 5% vs. 18. 3%）,low birth weight rate of newborn（29. 3% vs. 13. 3%） between the CKC group and control group（P〈0. 05）. Conclusion For patients with CIN,CKC treatment usually increase the risk of preterm birth.But LEEP treatment is relatively safe,and has no obvious adverse effects on the pregnancy outcomes;it is the prior methods for the patients who desired for fertility.