宫颈环形电切术导致的宫颈黏连高危因素及预防措施  

High risk factors and preventive measures of cervical adhesion caused by loop electrosurgical excision procedure

作　　者：林婧[1] 吴丹[1] 夏玮[1] 李柱南[1] 许颖[1] 吴佳皓[1] 丁李[1] 陈忆[1] 

机构地区：[1]中国福利会国际和平妇幼保健院,上海200030

出　　处：《中华妇幼临床医学杂志（电子版）》2016年第4期412-418,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：上海市卫生计生委2015年慢病防治项目(SHDC12015312)~~

摘　　要：目的探讨宫颈环形电切术(LEEP)导致宫颈黏连发生的高危因素,分析预防宫颈黏连发生的有效措施。方法选择2013年1月至2014年12月,于中国福利会国际和平妇幼保健院进行LEEP治疗后,采取预防宫颈黏连措施的绝经过渡期及绝经后期患者,纳入研究组(n=603);选择2003年1月至2012年12月,于本院进行LEEP治疗后,未采取预防宫颈黏连措施的患者,纳入未干预组(n=10 863)。根据研究组患者采取放置宫内节育器(IUD),即带尾丝T型环与采用Hegar子宫颈扩张棒物理扩张宫颈预防宫颈黏连措施的不同,将其进一步分为放置IUD亚组(n=144)与物理扩张亚组(n=459)。将未干预组绝经过渡期及绝经后期患者纳入对照组(n=2 270)。采用回顾性分析方法分析未干预组患者LEEP治疗导致的宫颈黏连发生率及相关危险因素。通过随访,前瞻性研究LEEP的宫颈黏连干预措施的效果。统计学比较研究组与对照组、放置IUD亚组与物理扩张亚组患者LEEP治疗导致的宫颈黏连发生率,以及放置IUD亚组与物理扩张亚组生殖道感染率。研究组与对照组、放置IUD亚组与物理扩张亚组患者的年龄、产次、疾病类型构成比、分娩方式等基本资料比较,差异均无统计学意义(P>0.05)。本研究遵循的程序符合中国福利会国际和平妇幼保健院伦理审查委员会制定的伦理学标准,得到该委员会批准,研究组患者接受宫颈黏连预防措施前,均获得其知情同意,并与之签署临床研究知情同意书。结果 1未干预组患者接受LEEP治疗后,宫颈黏连发生率为9.6%(1 042/10 863)。未干预组患者中,绝经过渡期及绝经后期、前次剖宫产分娩、宫颈锥切深度>10mm患者接受LEEP治疗后,宫颈黏连发生率均分别显著高于性成熟期、前次经阴道分娩、宫颈锥切深度≤10mm患者,并且差异均有统计学意义(χ2=3 692.23,P<0.001;χ2=5.11,P=0.024;χ2=15.72,P<0.002)。未干预组患者中,不同孕、产�Objective To investigate the high risk factors of cervical adhesion caused by loop electrosurgical excision procedure（LEEP）,and to find out the effective measures to prevent cervical adhesion caused by LEEP.Methods From January 2013 to December 2014,a total of 603 cases of menopausal transition and postmenopausal patients who received LEEP treatment in International Peace Maternity Child Health Hospital of China Welfare Institute with taking cervical adhesion prevention measures after LEEP were enrolled into study group.From January 2003 to December2012,a total of 10 863 cases of patients who received LEEP treatment in International Peace Maternity Child Health Hospital of China Welfare Institute without taking cervical adhesion prevention measures after LEEP were enrolled into non-intervention group.According to the different cervical adhesion prevention measures after LEEP in study group：placing intrauterine device（IUD）which was T type ring with tail wire once after the treatment of LEEP or using Hegar cervical dilator for physical cervical dilatation,the menopausal transition and postmenopausal patients in study group were further divided into IUD subgroup（n=144）and physical dilator subgroup（n=459）.And in the non-intervention group,the menopausal transition and postmenopausal women were included into control group（n=2 270）.The incidence of cervical adhesion caused by LEEP in non-intervention group and the related risk factors of cervical adhesion caused by LEEP were analyzed by retrospective analysis method.By following up the study group,the effects of cervical adhesion intervention measures were analyzed prospectively.The incidences of cervical adhesion caused by LEEP in study group and control group,and the incidences of cervical adhesion caused by LEEP and genital tract infection in IUD subgroup and physical dilator subgroup were statistically compared to evaluate the effects of the cervical adhesion intervention measures.There were no statistical differences between the study group a

关 键 词：子宫颈 宫颈上皮内瘤样病变 宫颈环形电切术 宫颈黏连 方案评价 

分 类 号：R737.33[医药卫生—肿瘤]