宫颈上皮内瘤变宫颈切除术比例作为妊娠结局预测指标

Proportion of cervical excision for cervical intraepithelial neoplasia as a predictor of pregnancy outcomes.

作者信息

Kyrgiou Maria, Valasoulis George, Stasinou Sofia-Melina, Founta Christina, Athanasiou Antonios, Bennett Phillip, Paraskevadis Evangelos

机构信息

Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK; West London Gynecological Cancer Center, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London, UK.

Department of Obstetrics and Gynecology-Gynecological Oncology, University Hospital of Ioannina, Ioannina, Greece; Department of Obstetrics and Gynaecology, Worthing Hospital, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK.

出版信息

Int J Gynaecol Obstet. 2015 Feb;128(2):141-7. doi: 10.1016/j.ijgo.2014.07.038. Epub 2014 Oct 2.

DOI:10.1016/j.ijgo.2014.07.038

PMID:25444615

Abstract

OBJECTIVE

To assess how the proportion of the cervical volume/length removed during treatment for cervical intraepithelial neoplasia (CIN) varies and whether this correlates to the pregnancy duration at delivery.

METHODS

The present prospective observational study included 142 women undergoing CIN treatment at a university hospital during 2009-2013. The pretreatment and post-treatment cervical dimensions and cone size were measured with magnetic resonance imaging, three-dimensional transvaginal ultrasonography, or two-dimensional transvaginal ultrasonography, and the correlation between pregnancy outcomes and the relative proportion of the cervix excised was assessed.

RESULTS

Pretreatment cervical volumes and cone volumes varied substantially (range 11-40 cm(3) and 0.6-8 cm(3), respectively). The proportion of the volume excised ranged from 2.2% to 39.4%. Sixteen (11%) women conceived following treatment; 12 had a live birth (seven at term, three preterm). The pregnancy duration at delivery was significantly correlated with the proportion of the cervical volume (r=-0.9; P<0.001) and length (r=-0.7; P=0.01) excised and the cone volume (r=-0.6; P=0.04).

CONCLUSION

The pretreatment cervical dimensions and the proportions of the volume/length excised vary substantially, and the latter correlates with the pregnancy duration. Assessment of the proportion excised might help to stratify women at risk who need intensive surveillance when pregnant.

摘要

目的

评估宫颈上皮内瘤变（CIN）治疗过程中切除的宫颈体积/长度比例如何变化，以及这是否与分娩时的孕周相关。

方法

本前瞻性观察性研究纳入了2009年至2013年期间在一所大学医院接受CIN治疗的142名女性。采用磁共振成像、三维经阴道超声或二维经阴道超声测量治疗前和治疗后的宫颈尺寸及锥切大小，并评估妊娠结局与切除的宫颈相对比例之间的相关性。

结果

治疗前宫颈体积和锥切体积差异很大（范围分别为11 - 40 cm³和0.6 - 8 cm³）。切除的体积比例在2.2%至39.4%之间。16名（11%）女性在治疗后怀孕；12名分娩，其中7名足月产，3名早产。分娩时的孕周与切除的宫颈体积比例（r = -0.9；P < 0.001）、长度比例（r = -0.7；P = 0.01）及锥切体积（r = -0.6；P = 0.04）显著相关。