宫颈锥切后发生早期早产和极期早产的Meta分析  

Early and Extremely Preterm Delivery Associated with Cervical Conisation:Meta-analysis

作　　者：陈英汉[1] 张弛远[1] 杨卓[1] 王一子[1] 王丹波[1] 

机构地区：[1]中国医科大学附属盛京医院,辽宁沈阳110003

出　　处：《辽宁大学学报（自然科学版）》2013年第2期176-184,共9页Journal of Liaoning University：Natural Sciences Edition

基　　金：国家自然科学基金项目面上项目(81070467)

摘　　要：目的:评价宫颈上皮内瘤样病变(CIN)行宫颈锥切术后发生早期早产和极期早产的相对危险度(RR).方法:检索PubMed、Embase,、Cochrane library、中国生物医学文献数据库、中国期刊全文数据库和清华同方数据库中从1960年1月至2012年3月之间的文献.纳入因CIN接受宫颈锥切或未接受宫颈锥切的妇女发生早期早产(<32/34周)和极期早产(<28/30周)的临床对照试验.按照Cochrane系统评价方法,采用RevMan 5.0版会聚RR和95%可信区间(95%CI).结果:2个前瞻性研究和16个回顾性研究被纳入.冷刀锥切后发生早期早产的风险显著增高(RR 3.49,95%CI 2.18～5.58),发生极期早产的风险更高(RR 10.38,95%CI 4.17～25.84).LEEP也会增加发生早期和极期早产的风险,但RR相对较小(分别为:RR 2.31,95%CI1.76～3.01;RR 2.17,95%CI 1.70～2.76).结论:因CIN行冷刀锥切和LEEP可能会增加发生早期和极度早产的风险.对照组的类型是比较这类研究结果时需要考虑的重要因素.Objective:To assess the relative risk of early and extremely preterm delivery associated with previous conisation for cervical intraepithelial neoplasia(CIN).Methods:PubMed,Embase,Cochrane library,CBM and Wanfang Data were searched for studies pubished between January 1960 and March 2012.Eligible studies were those that reported early(<32/34 weeks) and extremely(<28/30 weeks) preterm delivery outcomes for women with and without previous conisation for CIN.Cold knife conisation and loop electrosurgical excision procedure(LEEP) were distinguished.Pooled relative risks(RR) and 95% confidence intervals(95% CI) were computed by using the methods provided by the Cochrane Handbook for Systematic Reviews of Interventions RevMan 5.0 version.Results:Two prospective cohort and 16 retrospective studies were retrieved.Cold knife conisation was associated with a significantly increased risk of early preterm delivery(RR 3.49,95% CI 2.18~5.58) and a significantly higher risk of extremely preterm delivery(RR 10.38,95%CI 4.17~25.84).LEEP were also associated with a significantly/small increased risk of early preterm delivery(RR 2.31,95%CI 1.76~3.01) and extremely preterm delivery(RR 2.17,95%CI 1.70~2.76).Conclusions:In the treatment of CIN,cold knife conisation and probably LEEP are associated with an increased risk of subsequent both early and extremely preterm delivery.The type of comparison group used is an important consideration when comparing the outcomes of studies.

关 键 词：宫颈上皮内瘤变 宫颈锥切 早产 META分析 

分 类 号：R737.3[医药卫生—肿瘤]