宫颈环形电切术术后初次妊娠间隔时间与妊娠结局的关系分析  

Relationship between Pregnant Interval and Pregnant Outcome after LEEP

作　　者：袁静[1] 孟戈[1] 方瑞娟[1] 张颖[1] 臧春逸[1] 代荫梅[1] YUAN Jing;MENG Ge;FANG Ruijuan(Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院,北京100006

出　　处：《实用妇产科杂志》2018年第8期592-595,共4页Journal of Practical Obstetrics and Gynecology

基　　金：北京市医管局临床医学发展专项(编号:zy201406);北京市科委生物医药与生命科学创新培育研究(编号:Z161100000116065)

摘　　要：目的:探讨宫颈环形电切术(LEEP)术后至初次妊娠间隔时间与妊娠结局的关系。方法:选择2012年1月至2015年12月因宫颈上皮内瘤变(CIN)Ⅱ、CINⅢ于我院门诊行LEEP治疗并有妊娠意愿的患者115例,术后定期随访,观察并比较成功妊娠患者一般情况、病理结果、手术至妊娠间隔时间及妊娠结局,分析术后至妊娠间隔时间与妊娠结局的关系。结果:87例LEEP术后成功妊娠,其中早期流产9例(10.3%)、晚期流产9例(10.3%)、早产19例(21.8%)、足月产50例(57.6%)。不同妊娠结局患者一般情况、术前术后病理结果差异无统计学意义(P>0.05)。4组间LEEP手术至初次妊娠间隔时间比较,差异有统计学意义(F=3.265,P=0.025)。早期流产患者LEEP术后至初次妊娠间隔时间明显低于足月产患者(P=0.004)。LEEP术后妊娠间隔时间对妊娠结局影响的ROC曲线下面积为0.774(P<0.01),对不良妊娠结局具有较好的预测价值,其最佳切割值是13.5。LEEP术后至初次妊娠间隔时间<13.5月和≥13.5月患者比较,妊娠结局差异有统计学意义(P=0.023)。LEEP术后至初次妊娠间隔时间≥13.5月较<13.5月妊娠后流产发生率低。结论:LEEP术后初次妊娠间隔时间过短早期流产发生率增加,把握好术后妊娠间隔时间可显著降低不良妊娠结局的发生。Objective： To investigate the relationship between the pregnant interval after Loop Electrosurgical Excision Procedure（ LEEP） and pregnantoutcome.Methods： From January 2012 to December 2015,115 women who had undergone LEEP and had the intention of pregnancy after LEEP were included in this study.With regular follow-up after the operation,the general situation,pathological results,interval fromsurgery to pregnancy and pregnant outcome of patients with successful pregnancy were observed and compared.And the relationship between pregnancy interval and pregnancy outcome was analyzed.Results： Of 87 patients with successful pregnancy after LEEP,9 cases were early abortion（ 10. 3%）,9 cases were late abortion（ 10. 3%）,19 cases were premature delivery（ 21. 8%）,and 50 cases were full-term labor（ 57. 6%）. There was no significant difference on general condition,pathological results among the patients with different pregnant outcomes（ P〉0. 05）.There was significant difference between the 4 groups in the interval between LEEP operation and pregnancy（ F = 3. 265,P = 0. 025）. The interval between LEEP and pregnancy after early abortion was significantly lower than that of full-term patients（ P = 0. 004）. The area under the ROC curve of LEEP interval after pregnancy was 0. 774（ P〈0. 01）,which had good predictive value for bad pregnancy outcome,and the best cutting value（ cut off value） was 13. 5.There was a significant difference on pregnant outcome between the two groups in the interval less than 13. 5 months and more than 13. 5 months（ P = 0. 023）.The risk of abortion after pregnancy in the patients with the interval more than 13. 5 months was lower than the patients with the interval of less than13. 5 months.Conclusions： Women with a shorter time interval from LEEP to pregnancy have an increasedrisk for early abortion.The proper time of pregnancy after operation can significantly reduce the occurrence of adverse pregnant outcome.

关 键 词：宫颈上皮内瘤变 宫颈环形电切术 妊娠间隔时间 

分 类 号：R713.44[医药卫生—妇产科学]