Sagot P, Caroit Y, Winer N, Lopes P, Boog G
Fédération de Gynécologie-Obstétrique, Centre Hospitalier Régional Universitaire, Hopital Mère-Enfant, Nantes, France.
Eur J Obstet Gynecol Reprod Biol. 1995 Jan;58(1):53-8. doi: 10.1016/0028-2243(94)01986-h.
Carbon dioxide laser conisation is a very reliable surgical technique for cervical intraepithelial dysplasia. As cervical morphology and function are better preserved than with other techniques, obstetrical morbidity should be lower in the often young and pauciparous women who undergo this procedure. In our study comparing the course of 71 pregnancies (55 children) in 54 operated women with that of 82 pregnancies (59 children) in these same women before conisation, the rates for complications at the beginning of pregnancy were similar (respectively, 14.1% and 13.4%, early spontaneous abortions; 2.8% and 2.4%, extrauterine pregnancies; and no late spontaneous abortions). The increased risks of premature delivery (13.2% vs. 8.5%), chorioamnionitis (1.9% vs. 0%), premature rupture of membranes (1.9% vs. 0%) and prematurity (11.3% vs. 1.7%) were not statistically significant. Only the percentage of natural term births was significantly reduced (73.6% vs. 90%; P = 0.025), but this difference was no longer apparent after correction for the prevalence of associated obstetrical pathologies and prematurity and/or cesarean factors which was significantly greater for the 53 pregnancies that developed after carbon dioxide laser conisation.
二氧化碳激光锥切术是治疗宫颈上皮内瘤变非常可靠的外科技术。由于与其他技术相比,宫颈的形态和功能能得到更好的保留,对于接受该手术的往往年轻且未育的女性而言,产科发病率应该更低。在我们的研究中,比较了54名接受手术的女性中71次妊娠(55名儿童)的过程与这些女性在锥切术前82次妊娠(59名儿童)的过程,妊娠初期的并发症发生率相似(早期自然流产分别为14.1%和13.4%;宫外孕分别为2.8%和2.4%;无晚期自然流产)。早产(13.2%对8.5%)、绒毛膜羊膜炎(1.9%对0%)、胎膜早破(1.9%对0%)和早产(11.3%对1.7%)风险增加,但无统计学意义。只有足月自然分娩的比例显著降低(73.6%对90%;P = 0.025),但在对相关产科病理及早产和/或剖宫产因素的患病率进行校正后,这种差异不再明显,二氧化碳激光锥切术后发生的53次妊娠中这些因素的患病率显著更高。