宫颈锥切术对患者生育能力及妊娠结局的影响
发布时间：2018-08-23 08:28
【摘要】：目 的探讨宫颈锥切术对患者生育能力的影响及其相关妊娠结局的影响。方 法对2008年1月1日-2013年5月31日收治的86例因宫颈病变在我院实施宫颈锥切手术的患者进行随访,选取术前无原发性不孕症、有生育要求的45例患者作为宫颈锥切组,随机从同期妇产科门诊患者中抽取无宫颈锥切术史、有生育要求的妇女50例作为对照组。宫颈锥切方法目前主要采用两种,宫颈环形电切术(loop electrosurgical excision procedure,LEEP)和宫颈冷刀锥切术(cold knife conization,CKC)。通过查阅病案室相关病例资料,并对在我院和未在我院分娩的患者行电话随访：包括两组患者的一般情况、年龄、身高、体重、孕史、产史、不良孕产史、宫颈锥切术后锥体大小、宫颈锥切术后至怀孕的时间长短、怀孕期间是否因保胎而住院治疗、妊娠期间是否行宫颈环扎术、妊娠结局(流产、早产、足月产、胎膜早破)和终止妊娠方式(剖宫产、经阴分娩)结 果1.患者一般情况比较 宫颈锥切组和对照组的患者一般情况进行比较,差异均无统计学意义(P0.05)2.妊娠情况比较 宫颈锥切组45例患者中,有40例患者获得41次妊娠,妊娠率为88.8%(40/45)；对照组中46例患者获得47次妊娠,妊娠率为92.0%(46/50),两组妊娠率相比,差异无统计学意义(P0.05)3.妊娠结局比较(1)对流产、早产、胎膜早破的影响 宫颈锥切组36例已分娩患者中早产3例(8.3%)；对照组42例已分娩患者中早产2例,发生率4.8%(2/42)。宫颈锥切组胎膜早破3例,发生率为8.3%(3/36)；对照组中胎膜早破1例,发生率为2.3%(1/42)。宫颈锥切组40例已妊娠患者,5例流产,流产率12.5(5/40)；对照组46例已妊娠患者,5例流产,流产率10.9(5/46)。宫颈锥切组流产、早产、胎膜早破的发生率均高于对照组,但差异无统计学意义(P0.05)。(2)宫颈锥切高度与妊娠结局及宫颈环扎的关系 宫颈锥切组40例已妊娠妇女将宫颈锥切高度按照10mm,10-20mm,》10mm分3组,3组中患者流产率、早产率、胎膜早破发生率及剖宫产率随宫颈锥切的高度增加而增加,但3组两两比较,差异无统计学意义(p0.05)；36例已分娩患者中2例行宫颈环扎术,这两例患者的宫颈锥切高度均20mm,其中1例患者为冷刀锥切的宫颈锥体高度为30mm。宫颈锥切高度≥20mm是导致患者行宫颈环扎术的重要原因。(3)宫颈锥切手术至妊娠时间间隔与妊娠结局的关系 宫颈锥切组中宫颈锥切手术至妊娠时间间隔最短为4个月,最长为48个月,将患者按宫颈锥切手术距离妊娠时间间隔长短分3组,分别为6月组、6-12月组及≥12月组。将3组中的流产率、早产率、胎膜早破发生率及剖宫产率两两进行比较发现,宫颈锥切手术至妊娠时间间隔短于6个月组中早产发生率明显高于大于12月组,差异有统计学意义(P＝0.014)。比较三组中的流产率、胎膜早破发生率和剖宫产率,差异无统计学意义(P0.05)(4)宫颈锥切术与住院保胎治疗的关系 宫颈锥切组已分娩的患者36例,其中有14例在怀孕期间因“保胎”而住院治疗,保胎率为38.8(14/36)。2例患者因宫颈机能不全行宫颈环扎术,并一直卧床到妊娠结束；其余12例患者实际上无保胎指征,但因害怕宫颈管缩短导致流产而强烈自动要求住院,其中1例2次住院。对照组中42例已分娩的患者中,有3例在不同妊娠时期住院保胎,保胎率为7.1%(3/42)。宫颈锥切组高于对照组,差异有统计学意义(P=0.001)。4.对围生儿的影响 两组均无新生儿死亡,宫颈锥切组新生儿出生体重与对照组比较,低于对照组,差异有统计学意义(P=0.027)。5.终止妊娠方式比较(1)宫颈锥切组40例患者41次妊娠中,36例已分娩,22例行择期剖宫产,14例经阴道试产。阴道试产中共4例改行急症剖宫产,10例成功经阴道分娩。剖宫产率为72.7%(26/36),社会心理因素作为剖宫产手术指征的患者16例,去除此手术指征,剖宫产人数为10例,剖宫产率为27.7%(10/36)；对照组46例患者47次妊娠,42例已分娩,16例择期剖宫产,26例经阴道试产。阴道试产中共4例改行急症剖宫产,22例成功经阴道分娩。剖宫产率为47.6%(20/42),因社会心理因素要求剖宫产的患者9例,去除此手术指征,剖宫产患者11例,剖宫产率为26.1%(11/42)。宫颈锥切组剖宫产率高于对照组,差异有统计学意义(P=0.028)；已分娩病例、阴道试产成功率低于对照组,但差异无统计学意义(P0.05)。宫颈锥切术增加了患者社会心理因素手术指征,两组患者均去除社会心理因素手术指征,剖宫产率基本一致。(2)两组剖宫产指征比较 宫颈锥切组40例妊娠患者剖宫产指征为社会心理因素的患者占16例,比例为40.0%(16/40);对照组46例妊娠患者剖宫产指征为社会心理因素的患者占9例,比例为19.6%(9/46)。宫颈锥切组社会心理因素手术指征明显高于对照组,两组比较差异有统计学意义(P=0.037)。比较两组患者剖宫产指征的其他方面,差异均无统计学意义(P0.05)。结 论1.宫颈锥切术对宫颈病变患者的妊娠能力无明显影响。2.宫颈锥切术对流产、早产、胎膜早破发生率没有明显影响。3.宫颈锥切高度与不良围生结局无明显关系,但宫颈锥切高度≥20mm是导致患者行宫颈环扎术的重要原因。4.宫颈锥切手术至妊娠时间间隔短于6个月的患者早产率明显高于妊娠时间间隔大于12个月的患者。5.宫颈锥切术增加了妊娠期间保胎住院率6.宫颈锥切术没有导致新生儿死亡率增加,但新生儿出生体重明显降低。7.宫颈锥切术对阴道试产成功率没有明显影响,但明显增加了剖宫产率、主要是增加了社会心理因素这个剖宫产指征,没有增加其他方面剖宫产指征。
[Abstract]:Objective To investigate the effect of cervical conization on fertility and pregnancy outcome. Methods 86 patients with cervical lesions who underwent conization in our hospital from January 1, 2008 to May 31, 2013 were followed up. Forty-five patients without primary infertility and with fertility requirements were selected as cervical conization. Group A: 50 women without history of cervical conization and with fertility requirements were randomly selected from gynecology and obstetrics clinics at the same time as control group. Currently, there are mainly two methods of cervical conization: loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC). Relevant case data and telephone follow-up of patients in our hospital and those who did not give birth in our hospital: including the general situation of the two groups of patients, age, height, weight, pregnancy history, childbirth history, adverse pregnancy and childbirth history, the size of the cone after cervical conization, the length of conization to pregnancy, whether pregnancy due to fetal care and hospitalization, pregnancy period is The results of cervical cerclage, pregnancy outcomes (abortion, premature delivery, full-term delivery, premature rupture of membranes) and termination of pregnancy (cesarean section, vaginal delivery) 1. The general situation of patients compared with cervical conization group and control group of patients in general, the difference was not statistically significant (P 0.05). 2. Pregnancy compared with cervical conization group of 45 patients, There were 41 pregnancies in 40 patients (88.8% (40/45); 47 pregnancies in 46 patients in the control group (92.0% (46/50). There was no significant difference in pregnancy rate between the two groups (P 0.05). 3. Pregnancy outcomes (1) Premature labor, premature rupture of membranes, abortion in 36 patients in the cervical conization group (8.3%); Premature rupture of membranes in cervical conization group was 8.3% (3/36), and that in control group was 2.3% (1/42). 6) The incidence of abortion, premature delivery and premature rupture of membranes in the conization group were higher than those in the control group, but there was no significant difference (P 0.05). (2) The relationship between the height of conization and pregnancy outcome and cervical cerclage. 40 pregnant women in the conization group were divided into three groups according to the height of 10 mm, 10-20 mm, > 10 mm. The incidence of premature rupture and the rate of cesarean section increased with the height of cervical conization, but there was no significant difference between the three groups (p0.05). Cervical cerclage was performed in 2 of 36 patients who had given birth. The height of cervical conization was 20 mm in both of the 36 patients. The height of cervical conization was 30 mm in one of them. (3) The shortest interval between conization and pregnancy was 4 months and the longest was 48 months. Patients were divided into 3 groups according to the interval between conization and pregnancy: 6 months, 6-12 months. The rates of abortion, premature delivery, premature rupture of membranes and cesarean section were compared between the three groups. The incidence of premature delivery in the group with the interval between conization and pregnancy less than 6 months was significantly higher than that in the group with 12 months (P = 0.014). There was no significant difference between the rate of cervical conization and the rate of cesarean section (P 0.05) (4) The relationship between conization and hospitalization for fetal preservation was not significant (P 0.05). The other 12 patients had no indication of fetal preservation, but they had to be hospitalized for fear of cervical tube shortening, one of them had to be hospitalized twice. Compared with the control group, the birth weight of newborns in the conization group was lower than that in the control group (P = 0.027). 5. Comparison of termination methods of pregnancy (1) Of the 41 pregnancies in the conization group, 36 had given birth, 22 had elective cesarean section and 14 had a vaginal trial. The cesarean section rate was 72.7% (26/36), and 16 patients with psychosocial factors as the indication of cesarean section were removed. The number of cesarean section was 10, and the cesarean section rate was 27.7% (10/36); 46 patients in the control group had 47 pregnancies, 42 had given birth, 16 had elective cesarean section, and 26.7% (10/36). The cesarean section rate was 47.6% (20/42). 9 patients were required to undergo cesarean section because of social and psychological factors. The cesarean section rate was 26.1% (11/42). The cesarean section rate in the conization group was higher than that in the control group. The difference was statistically significant. There was no significant difference between the two groups (P = 0.028). (2) The cesarean section rate was basically the same between the two groups. (2) Comparing the cesarean section indications between the two groups, the cervical conization group had 40 cases. 16 pregnant women with cesarean section indications for social and psychological factors accounted for 40.0% (16/40); the control group of 46 pregnant women with cesarean section indications for social and psychological factors accounted for 9 cases, the proportion was 19.6% (9/46). Cervical conization group of social and psychological factors of surgical indications were significantly higher than the control group, the difference was statistically significant (P = 0.037). Conclusion 1. Conization of cervix has no significant effect on the pregnant ability of patients with cervical lesions. 2. Conization of cervix has no significant effect on the incidence of abortion, premature delivery and premature rupture of membranes. The cervical conization height (> 20 mm) is an important reason for cervical cerclage. 4. The premature delivery rate of patients whose interval between conization and pregnancy is shorter than 6 months is significantly higher than that of patients whose interval between pregnancy is longer than 12 months. 5. The cervical conization increases the hospitalization rate of pregnancy. 6. Cervical conization does not lead to neonatal mortality. Cervical conization did not significantly affect the success rate of vaginal delivery, but significantly increased the rate of cesarean section, mainly increased the social and psychological factors of cesarean section indications, did not increase other aspects of cesarean section indications.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.2
[Abstract]:Objective To investigate the effect of cervical conization on fertility and pregnancy outcome. Methods 86 patients with cervical lesions who underwent conization in our hospital from January 1, 2008 to May 31, 2013 were followed up. Forty-five patients without primary infertility and with fertility requirements were selected as cervical conization. Group A: 50 women without history of cervical conization and with fertility requirements were randomly selected from gynecology and obstetrics clinics at the same time as control group. Currently, there are mainly two methods of cervical conization: loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC). Relevant case data and telephone follow-up of patients in our hospital and those who did not give birth in our hospital: including the general situation of the two groups of patients, age, height, weight, pregnancy history, childbirth history, adverse pregnancy and childbirth history, the size of the cone after cervical conization, the length of conization to pregnancy, whether pregnancy due to fetal care and hospitalization, pregnancy period is The results of cervical cerclage, pregnancy outcomes (abortion, premature delivery, full-term delivery, premature rupture of membranes) and termination of pregnancy (cesarean section, vaginal delivery) 1. The general situation of patients compared with cervical conization group and control group of patients in general, the difference was not statistically significant (P 0.05). 2. Pregnancy compared with cervical conization group of 45 patients, There were 41 pregnancies in 40 patients (88.8% (40/45); 47 pregnancies in 46 patients in the control group (92.0% (46/50). There was no significant difference in pregnancy rate between the two groups (P 0.05). 3. Pregnancy outcomes (1) Premature labor, premature rupture of membranes, abortion in 36 patients in the cervical conization group (8.3%); Premature rupture of membranes in cervical conization group was 8.3% (3/36), and that in control group was 2.3% (1/42). 6) The incidence of abortion, premature delivery and premature rupture of membranes in the conization group were higher than those in the control group, but there was no significant difference (P 0.05). (2) The relationship between the height of conization and pregnancy outcome and cervical cerclage. 40 pregnant women in the conization group were divided into three groups according to the height of 10 mm, 10-20 mm, > 10 mm. The incidence of premature rupture and the rate of cesarean section increased with the height of cervical conization, but there was no significant difference between the three groups (p0.05). Cervical cerclage was performed in 2 of 36 patients who had given birth. The height of cervical conization was 20 mm in both of the 36 patients. The height of cervical conization was 30 mm in one of them. (3) The shortest interval between conization and pregnancy was 4 months and the longest was 48 months. Patients were divided into 3 groups according to the interval between conization and pregnancy: 6 months, 6-12 months. The rates of abortion, premature delivery, premature rupture of membranes and cesarean section were compared between the three groups. The incidence of premature delivery in the group with the interval between conization and pregnancy less than 6 months was significantly higher than that in the group with 12 months (P = 0.014). There was no significant difference between the rate of cervical conization and the rate of cesarean section (P 0.05) (4) The relationship between conization and hospitalization for fetal preservation was not significant (P 0.05). The other 12 patients had no indication of fetal preservation, but they had to be hospitalized for fear of cervical tube shortening, one of them had to be hospitalized twice. Compared with the control group, the birth weight of newborns in the conization group was lower than that in the control group (P = 0.027). 5. Comparison of termination methods of pregnancy (1) Of the 41 pregnancies in the conization group, 36 had given birth, 22 had elective cesarean section and 14 had a vaginal trial. The cesarean section rate was 72.7% (26/36), and 16 patients with psychosocial factors as the indication of cesarean section were removed. The number of cesarean section was 10, and the cesarean section rate was 27.7% (10/36); 46 patients in the control group had 47 pregnancies, 42 had given birth, 16 had elective cesarean section, and 26.7% (10/36). The cesarean section rate was 47.6% (20/42). 9 patients were required to undergo cesarean section because of social and psychological factors. The cesarean section rate was 26.1% (11/42). The cesarean section rate in the conization group was higher than that in the control group. The difference was statistically significant. There was no significant difference between the two groups (P = 0.028). (2) The cesarean section rate was basically the same between the two groups. (2) Comparing the cesarean section indications between the two groups, the cervical conization group had 40 cases. 16 pregnant women with cesarean section indications for social and psychological factors accounted for 40.0% (16/40); the control group of 46 pregnant women with cesarean section indications for social and psychological factors accounted for 9 cases, the proportion was 19.6% (9/46). Cervical conization group of social and psychological factors of surgical indications were significantly higher than the control group, the difference was statistically significant (P = 0.037). Conclusion 1. Conization of cervix has no significant effect on the pregnant ability of patients with cervical lesions. 2. Conization of cervix has no significant effect on the incidence of abortion, premature delivery and premature rupture of membranes. The cervical conization height (> 20 mm) is an important reason for cervical cerclage. 4. The premature delivery rate of patients whose interval between conization and pregnancy is shorter than 6 months is significantly higher than that of patients whose interval between pregnancy is longer than 12 months. 5. The cervical conization increases the hospitalization rate of pregnancy. 6. Cervical conization does not lead to neonatal mortality. Cervical conization did not significantly affect the success rate of vaginal delivery, but significantly increased the rate of cesarean section, mainly increased the social and psychological factors of cesarean section indications, did not increase other aspects of cesarean section indications.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.2
【相似文献】
相关期刊论文 前10条
1 石少权;郝丽娟;姜芳芳;洪婷;庄圆;王桂荣;王峰;;改良宫颈锥切术临床效果研究[J];中国实用妇科与产科杂志;2013年01期
2 冯梅;李秀华;;宫颈锥切术29例临床分析[J];福建医药杂志;2006年05期
3 王冬军;赵玉芳;;118例宫颈锥切术后病人的护理[J];护理研究;2008年32期
4 陈兢思;陈敦金;;宫颈锥切术对生育的影响[J];实用妇产科杂志;2009年07期
5 严沁;万小平;;宫颈锥切术的指征[J];实用妇产科杂志;2009年07期
6 周慧梅;朱兰;;诊断性与治疗性宫颈锥切术的临床价值[J];实用妇产科杂志;2009年07期
7 袁德利;;宫颈锥切术后大出血16例临床分析[J];中国当代医药;2009年20期
8 王丹;宋薇薇;;宫颈锥切术及根治性宫颈切除术后妊娠相关问题[J];中国实用妇科与产科杂志;2010年04期
9 刘国艳;薛凤霞;;宫颈锥切术对妊娠及分娩方式的影响[J];中国实用妇科与产科杂志;2010年04期
10 王淑霞;;宫颈锥切术联合沙棘籽油栓治疗宫颈上皮内病变45例疗效观察[J];河南外科学杂志;2010年02期
相关会议论文 前4条
1 常俊丽;王爱云;;宫颈锥切术前术后护理41例[A];河南省肿瘤全科护理学术交流会议资料汇编[C];2005年
2 辛虹;;宫颈锥切术对妊娠及分娩的影响[A];第五届环渤海围产医学学术会议暨山东省第四次围产医学学术会议论文汇编[C];2012年
3 马永静;熊英;;宫颈上皮内瘤样病变Ⅲ级行宫颈锥切术的临床价值[A];2011首届宁夏生殖医学学术年会资料汇编[C];2011年
4 卢红鲜;陈亚侠;万小云;吕卫国;谢幸;;CINⅢ宫颈锥切术切缘阳性因素及处理[A];第四届长三角妇产科学术论坛暨浙江省2009年妇产科学术年会论文汇编[C];2009年
相关硕士学位论文 前10条
1 翟军迎;宫颈锥切术对患者生育能力及妊娠结局的影响[D];山东大学;2016年
2 林青;22例宫颈锥切术后预防性腹腔镜宫颈环扎的临床分析[D];山东大学;2016年
3 李玲玲;宫颈锥切术770例的临床分析[D];吉林大学;2011年
4 王s，
本文编号：2198488
本文链接：https://www.wllwen.com/yixuelunwen/fuchankeerkelunwen/2198488.html
最近更新
教材专著
