【作者】 陈敏；

【导师】 颜建英；

【作者基本信息】 福建医科大学 ， 妇产科学， 2015， 硕士

【摘要】 目的宫颈上皮内瘤变(cervieal intraepithelial neoplasia,CIN)是与宫颈癌发生密切相关的癌前病变。宫颈环形电切术(loop electrosurgical excision procedure,LEEP)是目前治疗CIN的主要方法之一,但LEEP术是否影响未来受孕能力及妊娠结局,目前仍存争议。本文旨在对既往发表的文献进行meta分析,以评价CIN行LEEP术治疗对妊娠母儿相关结局的影响。方法检索Pub Med、Cochrane Library、CNKI、CBM、万方、维普等电子数据库上发表的有关CIN行LEEP对妊娠母儿结局影响的病例-对照研究(case-control study),采用Revman5.3软件进行统计分析,分析病例组(CIN患者LEEP术后妊娠)与对照组(无宫颈治疗史或健康妊娠者)间妊娠母儿相关结局,包括受孕率、流产、异位妊娠、引产、早产、剖宫产、胎膜早破、前置胎盘、产后出血、急产、产钳与胎头吸引助产、宫颈裂伤、低出生体重儿、胎儿窘迫、新生儿窒息及病死率的风险比(risk ratio,RR)及95%可信区间(confidence interval,CI)。结果纳入的40篇病例-对照研究共有9002例病例,其中病例组4196例、对照组4806例。meta分析结果显示,与对照组比较,CIN患者LEEP术后妊娠情况:⑴妊娠早中期相关结局:流产(RR=1.34,95%CI:1.14~1.57)风险增加,差异有统计学意义(P﹤0.05),而受孕率、引产及异位妊娠与对照组比较差异无统计学意义(均P>0.05);⑵妊娠晚期母儿相关结局:①孕产妇方面,早产(RR=1.60,95%CI:1.37~1.86,P﹤0.05)、未足月胎膜早破(RR=2.72,95%CI:1.46~5.07,P﹤0.05)风险明显增加,此外,病例组中因社会因素引起的剖宫产(RR=2.12,95%CI:1.64~2.76)发生率高于对照组,差异有统计学意义(P﹤0.05),而总胎膜早破、剖宫产、前置胎盘及产后出血与对照组比较差异无统计学意义(均P>0.05);②围产儿方面,低出生体重儿发生率(RR=1.35,95%CI:1.10~1.66,P﹤0.05)显著增加,而胎儿窘迫、新生儿窒息及病死率与对照组比较差异无统计学意义(均P>0.05);③分娩方式及其并发症方面,无明显证据表明LEEP术将会增加急产、产钳与胎头吸引助产及宫颈裂伤的风险,差异无统计学意义(均P>0.05)。结论LEEP术与流产、早产、未足月胎膜早破、因社会因素引起的剖宫产及低出生体重儿发生相关,增加上述情况的发生风险。对于有生育要求的CIN患者,LEEP术前应充分告知妊娠不良结局的风险。更多还原

【Abstract】 Objective Cervical intraepithelial neoplasia(CIN) is a kind of cervical precancerous lesions which is closely related to cervical cancer. The loop electrosurgical excision procedure(LEEP) has become one of the main treatment of CIN nowadays. But it still exists a lot of disputes about whether LEEP will affect the future fertility ability and pregnancy outcomes. This study aimed at assessing the association of the treatment safety and the related pregnancy outcomes with previous treatment of LEEP for CIN.Methods A thorough search of Pub Med、Cochrane Library、CNKI、CBM、Wanfang and Cq Vip electronic database was performed. Case-control studies about pregnancy outcomes after previous treatment of LEEP for CIN were collected and meta-analysis was carried out with Rev Man5.3 software, through an analysis of related pregnancy outcomes between study group(women with previous LEEP for CIN) and control group(women without previous cervical surgical history or health women), including the risk ratio(RR) and 95% confidence intervals(95%CI) of the incidence of pregnancy, miscarriage, ectopic pregnancy, induced labor, preterm delivery, cesarean section, premature rupture of membranes, placenta previa, postpartum hemorrhage, precipitate labour, forceps delivery and vacuum extraction delivery, cervical laceration, low birth weight, fetal distress, neonatal asphyxia and mortality.Result Forty case-control studies including 9002 patients were enrolled in this study with 4196 patients in study group and 4806 patients in control group. For women with previous LEEP for CIN, meta-analysis revealed that: ⑴. The incidence of miscarriage was significantly increased in study group as compared with that of control group(RR=1.34, 95%CI: 1.14~1.57, P﹤0.05), no significant difference was found in the incidence of pregnancy, ectopic pregnancy and induced labor with respect to the first, mid trimester of pregnancy between study group and control group(P>0.05 each); ⑵. ①. For maternal, LEEP was associated with a higher risk of preterm delivery(RR=1.60, 95%CI: 1.37~1.86, P﹤0.05), preterm premature rupture of membranes(RR=2.72, 95%CI: 1.46~5.07, P﹤0.05), cesarean section due to social factors(RR=2.12, 95%CI: 1.64~2.76, P﹤0.05), no significant difference was found in the incidence of premature rupture of membranes, cesarean section, placenta previa, postpartum hemorrhage in regard to the perinatal period(the late trimester of pregnancy) between study group and control group(P>0.05 each); ②. For perinatal infants, the incidence of low birth weight was obviously increased in study group(RR=1.35, 95%CI: 1.10~1.66, P﹤0.05), no significant difference was found in the incidence of fetal distress、neonatal asphyxia and mortality during perinatal period between study group and control group(P>0.05 each); ③. For delivery way and complications, LEEP was not associated with a significantly increased risk of precipitate labour, forceps delivery and vacuum extraction delivery, and cervical laceration(P>0.05 each).Conclusion LEEP is associated with an increased risk of miscarriage, preterm delivery, preterm premature rupture of membranes, cesarean section due to social factors, low birth weight. For CIN patients with fertility requirements, the risk of adverse pregnancy outcomes should be fully informed before LEEP.更多还原