Hagen B, Skjeldestad F E
Trondheim University Hospital, Department of Obstetrics and Gynaecology, Norway.
Br J Obstet Gynaecol. 1993 Aug;100(8):717-20. doi: 10.1111/j.1471-0528.1993.tb14261.x.
To investigate the effect of laser conisation of the cervix on the outcome of subsequent pregnancy.
Case-control study.
Department of Obstetrics & Gynaecology, University Hospital, Trondheim, Norway.
Three hundred and fifty-one women were treated for cervical intra-epithelial neoplasia (CIN) by laser conisation of the cervix between 1 January 1983 and 31 December 1985. The 56 women among them who had been delivered of live infants beyond 22 weeks gestation after the conisation and before 1 January 1991 were studied for the outcome of their pregnancies. For each case, two controls of equal parity and age (+/- 3 years) were selected.
The length of gestation and birthweight of the infants.
The median (range) length of gestation was 39 weeks (26-43) in cases compared with 40 weeks (34-42) in controls (z = -4.0, P < 0.001). The median (range) birthweight was 3330 g (1150-4940) in cases and 3630 g (1610-5080) in controls (z = -3.5, P < 0.001). Overall 38% of cases were delivered preterm (< or = 37 weeks gestation), compared with 6% of controls (P < 0.0001; odds ratio 9.0, 95% CI 3.7-21.7). A logistic regression analysis of a set of possible confounding factors revealed no significant risk factors in addition to conisation for the occurrence of preterm delivery. No correlation was found between the height of the cone and the occurrence of preterm delivery in subsequent pregnancy.
Conisation with microsurgical laser technique increases the risk of preterm delivery in subsequent pregnancies. Laser conisation in young women should be restricted to those with high grade CIN or a lesion extending into the endocervical canal.
探讨宫颈激光锥切术对后续妊娠结局的影响。
病例对照研究。
挪威特隆赫姆大学医院妇产科。
1983年1月1日至1985年12月31日期间，351名妇女接受了宫颈激光锥切术治疗宫颈上皮内瘤变（CIN）。其中56名妇女在锥切术后至1991年1月1日前分娩了孕周超过22周的活婴，对其妊娠结局进行研究。为每个病例选取两名年龄和胎次相同（±3岁）的对照。
婴儿的孕周和出生体重。
病例组的孕周中位数（范围）为39周（26 - 43周），对照组为40周（34 - 42周）（z = -4.0，P < 0.001）。病例组的出生体重中位数（范围）为3330 g（1150 - 4940 g），对照组为3630 g（1610 - 5080 g）（z = -3.5，P < 0.001）。总体而言，38%的病例早产（孕周≤37周），而对照组为6%（P < 0.0001；比值比9.0，95%可信区间3.7 - 21.7）。对一组可能的混杂因素进行逻辑回归分析显示，除锥切术外，没有其他导致早产的显著危险因素。未发现锥切高度与后续妊娠早产发生率之间存在相关性。
显微外科激光技术锥切术会增加后续妊娠早产的风险。年轻女性的激光锥切术应仅限于患有高级别CIN或病变延伸至宫颈管内的患者。
