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1、宫颈电环锥切术和冷刀锥切术对妊娠影响的对照分析【摘要】目的探讨宫颈LEEP(Loopelectrosurgicalexcisionprocedure,LEEP)和CKC(coldknifeconization)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(14/3
2、6,38.88%)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
3、)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12 [Abstract]ObjectiveToexaminetheconsequencesofcervicalconisationintermsofadverseoutcomeinsubsequentpregnancies.MethodsFrom2005Januaryto2009January,patientswithrequesto
4、fpregnancy,whoreceivedLEEPorCKCsurgeryatourhospitalbecauseofCINlesionswerechosenasthestudysubjects.Women,alsowithrequestofpregnancy,whoonlyreceivedcolposcopicbiopsyandnoanyothercervicalsurgeryatthesametimewereappointedtothecontrolgroup.Thesubsequentpregnancyoutcomesinclud
5、ingpreterm,meangestationalweeks,modeofdelivery,lowneonatalbirthweightwerecomparedbetweenLEEPorCKCgroupandthecontrolgroup.Logisticregressionanalyseswereusedtoevaluateassociationbetweenconecharacteristicsandthesubsequentriskofpretermdelivery.Thethreegroupsweresimilarinage,g
6、ravidityandobstetriccomplicationsrelevanttopretermpregnancy.ResultsTheproportionofpretermdeliverywassignificantlyhigherinCKCgroup(14/36,38.88%)thanthecontrolgroup(14/68,20.59%)(P=0.048)andtheoddsriskincreasedto2.455(1.007~5.985).WhilepretermrateinLEEPgroup(10/48,20.83%)ha
7、dnodifferencecomparedwiththecontrolgroup.Theoccurrenceofpretermpregnancywasassociatedwithconedepth.Increasingconedepthwasassociatedwithincrease12intheriskofpretermdelivery.Whenconedepthreached15mm,theriskofpretermdeliveryincreasedsignificantly.TheaverageweekinCKCgroup(36.
8、9±2.4)wasshorterthancontrolgroup(37.8±2.6)(P=0.049).WhileLEEPgroup(38.1±2.4)hadnodifferencewithc
