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目的分析宫颈上皮内瘤变(CIN)行宫颈锥切术后患者的妊娠结局。方法回顾性分析营口市妇产儿童医院2011-2015年收治的13例因CINⅡ~Ⅲ实施宫颈锥切术患者的临床资料,比较锥切范围、妊娠距锥切术间隔时间、妊娠周数、宫颈长度、妊娠结局和终止妊娠方式。结果大锥切组发生宫颈机能不全3例,小锥切组无宫颈机能不全发生。术后<6个月妊娠组中1例发生自然流产、1例早产;术后>6个月妊娠合并大锥切中有2例发生早产;足月妊娠9例;阴道分娩5例,剖宫产7例。3例患者分别在孕14周、16~(+2)周、17~(+1)周产检超声示宫颈管长度不同程度缩短,行宫颈环扎术。术后<6个月妊娠组妊娠中期宫颈管长度与>6个月妊娠组比较,差异有统计学意义(P<0.05),妊娠晚期宫颈管长度与妊娠中期比较,差异无统计学意义(P>0.05);妊娠中期大锥切组与小锥切组、妊娠晚期大锥切组与小锥切组比较,差异有统计学意义(均P<0.05)。锥切组妊娠中期与对照组A、妊娠晚期与对照组B宫颈管长度比较,差异无统计学意义(P>0.05)。结论宫颈锥切术后<6个月妊娠、大锥切与不良妊娠结局有关。要准确掌握宫颈锥切手术指征及手术范围,有宫颈锥切史的孕妇应作为高危孕妇,对于宫颈机能不全的孕妇适时行宫颈环扎术至关重要,可有效降低宫颈锥切术的不良妊娠结局。
Objective To analyze the pregnancy outcome of cervical intraepithelial neoplasia (CIN) after cervical conization. Methods A retrospective analysis of Yingkou maternity and childrens hospitals in 2011-2015 admitted to 13 cases of CIN Ⅱ ~ Ⅲ implementation of cervical conization in patients with clinical data, cone conization range, interval from pregnancy to conization, pregnancy weeks, cervix Length, pregnancy outcome and termination of pregnancy. Results Large conization group occurred cervical insufficiency in 3 cases, small conization group without cervical incompetence. One case of spontaneous abortion and one case of preterm labor were found in 1 month after operation in 6 months pregnant group. Premature delivery occurred in 2 cases of conization with large conization in 6 months after pregnancy. Nine cases of full-term pregnancy, 5 cases of vaginal delivery and cesarean section 7 cases. Three cases of patients were 14 weeks pregnant, 16 (+2) weeks, 17 +1 (+1) weeks ultrasound showed cervical canal length to varying degrees, cervical cerclage. There was a significant difference in cervical canal length between the second trimester and the third trimester (P <0.05), while there was no significant difference between the third trimester and the second trimester > 0.05). There was a significant difference between mid-pregnancy large conization group and small conization group, late pregnancy conization group and small conization group (all P <0.05). There was no significant difference in the length of cervical canal between conception group and control group A in the third trimester of pregnancy and in the third trimester of pregnancy (P> 0.05). Conclusion Cervical conization <6 months after pregnancy, conization and adverse pregnancy outcomes. To accurately grasp the indications and surgical scope of cervical conization, pregnant women with a history of cervical conization should be used as high-risk pregnant women, timely cervical cerclage is essential for pregnant women with cervical insufficiency, which can effectively reduce the adverse cervical conization Pregnancy outcome.