van Velthoven Kim, Poppe Willy, Verschuere Hannah, Arbyn Marc
Department of Obstetrics and Gynaecology, University Hospitals Leuven, Campus Gasthuisberg Leuven, Belgium.
Department of Obstetrics and Gynaecology, University Hospitals Leuven, Campus Gasthuisberg Leuven, Belgium.
Eur J Obstet Gynecol Reprod Biol. 2017 Sep;216:224-231. doi: 10.1016/j.ejogrb.2017.06.043. Epub 2017 Jun 29.
To evaluate whether the dimensions of the cones removed during large loop excision of the transformation zone have decreased over time. Secondly, whether these changes were associated with a lower risk of obstetrical harms on a subsequent pregnancy.
A retrospective matched cohort study was performed in a tertiary referral unit in Belgium. A total of 97 women were identified from a database of women who underwent excisional treatment for cervical precancer between January 1st, 2004 and December 31st, 2012, and delivered before December 31st, 2014. The control group consisted of 120 non-treated women who had no history of cervical intra-epithelial neoplasia. Data on smoking status; gestational age at delivery; number of conisations; time interval between treatment and pregnancy; dimensions of the cone; severity of the lesion; and the extra resection of endocervical tissue were collected. These data were compared with those from a previous similar study at the University Hospital of Leuven in 2009, which database we enriched with information on the cone dimensions. Main outcome variables were gestational age at delivery, birthweight and neonatal condition at birth.
Only a significant lower birthweight could be found in the treated group compared to the control group (3364g [95% CI 3094-3290] versus 3364g [95% CI 3253-3475], P=0.023). The current study showed no increase in preterm birth rate after conisation and no relationship between volume or depth of the cone and preterm birth could be found. Over the period 1999-2014, a significant decrease in all dimensions was observed: on average -0.3mm, -0.3mm, -0.4mm and -132mm per year, for the depth, anteroposterior and transverse diameter and the volume, respectively.
Our two successive studies showed a significant trend towards smaller cones which was accompanied by a decrease in preterm birth after excisional treatment. The clinician could limit the size of the cone to avoid obstetrical harms, but needs to be aware of the oncological safety as well.
评估在转化区大环形切除术期间切除的锥形组织尺寸是否随时间减小。其次，这些变化是否与后续妊娠时较低的产科危害风险相关。
在比利时的一家三级转诊单位进行了一项回顾性匹配队列研究。从2004年1月1日至2012年12月31日期间接受宫颈癌前病变切除治疗且在2014年12月31日前分娩的女性数据库中识别出97名女性。对照组由120名无宫颈上皮内瘤变病史的未治疗女性组成。收集了吸烟状况、分娩时的孕周、锥切术次数、治疗与妊娠之间的时间间隔、锥形组织尺寸、病变严重程度以及宫颈管内膜组织的额外切除情况等数据。将这些数据与2009年鲁汶大学医院之前一项类似研究的数据进行比较，我们在该研究数据库中补充了有关锥形组织尺寸的信息。主要结局变量为分娩时的孕周、出生体重和出生时的新生儿状况。
与对照组相比，治疗组仅出生体重显著降低（3364克[95%可信区间3094 - 3290] 对 3364克[95%可信区间3253 - 3475]，P = 0.023）。当前研究显示锥切术后早产率未增加，且未发现锥形组织的体积或深度与早产之间存在关联。在1999 - 2014年期间，观察到所有尺寸均显著减小：深度、前后径、横径和体积平均每年分别减小0.3毫米、0.3毫米、0.4毫米和132立方毫米。
我们的两项连续研究显示出锥形组织尺寸显著变小的趋势，同时切除治疗后早产率降低。临床医生可以限制锥形组织的大小以避免产科危害，但也需要注意肿瘤学安全性。
