子宫颈上皮内瘤变Ⅲ级冷刀锥切术后妊娠结局  

Pregnancy outcomes after cold-knife conization of patients with cervical intraepithelial neoplasia Ⅲ

作　　者：李寒松[1] 吕爱明[1] 罗立华[1] 张毅[1] 

机构地区：[1]北京卫生部北京医院妇产科,100730

出　　处：《中国妇产科临床杂志》2010年第3期185-187,共3页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨子宫颈冷刀锥切术(cold-knife conization,CKC)对妊娠结局的影响。方法回顾性分析2006年1月至2009年6月因子宫颈上皮内瘤变III级(cervical intraepithelial neoplasiaⅢ,CINⅢ)行冷刀锥切术的41例(锥切组)患者的妊娠结局,并将其与同期无宫颈病变治疗史妊娠分娩的4 446例孕妇(对照组)进行比较。结果 41例患者中,3～6个月内妊娠者5例,6～12个月妊娠者17例,12～24个月妊娠者14例,2年后妊娠者5例。7例孕早期行人工流产,2例孕早期自然流产,1例晚期流产,31例成功分娩(75.61%),其中5例(16.13%)早产,26例(83.87%)足月分娩;阴道分娩23例,无宫颈性难产,剖宫产8例。与对照组比较,锥切组的妊娠时限短于对照组(P<0.001);锥切组早产率高于对照组[8.57%(381/4 446)](P<0.01);锥切组胎膜早破率[19.35%(6/31)]高于对照组[7.11%(316/4 446)](P<0.01);锥切组早产胎膜早破[9.68%(3/31)]高于对照组[1.17%(52/4 446)](P<0.001);新生儿出生体重2 511～4 050 g,无新生儿窒息。两组新生儿出生体重比较,差异无统计学意义(P>0.05);宫颈裂伤和分娩方式比较,差异无统计学意义(P>0.05)。结论宫颈冷刀锥切术是孕中期流产、早产和早产胎膜早破的高危因素,不增加宫颈裂伤的发生率,不影响分娩方式。Objective To investigate the effects of cold-knife conization（CKC） on pregnancy and delivery outcomes of patients with cervical carcinoma in situ.Methods 41 women with cervical intraepithelial neoplasia III（CIN Ⅲ）who had underwent CKC from January 2006 to June 2009 were studied retrospectiveiy,4 446 healthy women who had deliveried during the same period were served as control.Results 5 patients were pregnant in 6 months after CKC（The first patient was pregnant in the third month after CKC）,17 patients in 6～12 months,14 patients in 12～24 months,5 patients after 2 years.7 patients underwent artificial abortion,2 patients with spontaneous miscarriages.1 patient miscarriaged at 25 weeks.31（75.61%）women had delivery,5（16.13%）patients with preterm birth.There were 26（83.87%）term pregnancies,23 of them via vaginal delivery and 8 underwent caesarean section.No cervical dystosia occurred.No asphyxia occurred.We found significant shorter duration of pregnancies in the conization group（P〈0.001）.Rate of delivery prior 37 weeks was 16.13%（5/31） in the conization group and in 8.57%（381/4 446） of the controls（P〈0.001）.Rate of premature rupture of the membranes occurred in 19.35%（6/31）in the conization group and 7.11%（316/4 446）in the controls（P〈0.01）.Rate of preterm premature rupture of the membranes（pPROM） was 9.68%（3/31） in the conization group and 1.17%（52/4 446）in control group（P〈0.001）.The birth weight of newborns ranged from 2 511 g to 4 050 g.All newborns had a high Apgar score.There was no difference in the mode of delivery,cervical tears and birth weight.Conclusions Cold-knife conization is a risk factor for preterm birth and preterm premature rupture of the membranes but not a risk factor for cervical tears and low birth weight.CKC does not affect the mode of delivery.

关 键 词：宫颈上皮内瘤变 宫颈冷刀锥切术 早产 胎膜早破 妊娠结局 

分 类 号：R737.33[医药卫生—肿瘤]