Baldauf J J, Dreyfus M, Ritter J, Meyer P, Philippe E
Department of Obstetrics and Gynecology 1, Hautepierre University Hospital, Strasbourg, France.
Obstet Gynecol. 1996 Dec;88(6):933-8. doi: 10.1016/S0029-7844(96)00331-6.
To assess the frequency of cervical stenosis in patients treated by laser conization or the loop electrosurgical excision procedure and to determine the preoperative and therapeutic factors associated with its occurrence.
Two hundred fifty-five women treated by laser conization and 277 treated by loop electrosurgical excision procedure were followed regularly by postoperative colposcopy for mean periods of 38 and 16 months, respectively. Stenosis was defined as cervical narrowing that prevented insertion of a 2.5-mm Hegar dilator.
Thirty-eight cases of cervical stenosis, of which seven were complete, were diagnosed up to 28 months after treatment. The risk of postoperative cervical stenosis was higher for patients over 50 years of age (relative risk [RR] 3.07, 95% confidence interval [95% CI] 1.30, 7.26; P = .031), for those with a totally endocervical lesion (RR 3.79, 95% CI 1.88, 7.62; P = .001), for those with an excision 20 mm high or greater (RR 2.96, 95% CI 1.63, 5.38; P = .005), and for those with laser conization (RR 2.35, 95% CI 1.24, 4.46; P = .009). Parity, menopause, previous treatment for cervical intraepithelial neoplasia, satisfactory colposcopy, size of the lesion, its histologic diagnosis, and the extent of excision did not increase the risk for cervical stenosis. Excision was not as high with loop electrosurgical excision as with laser conization (14.3 +/- 5.0 mm versus 20.2 +/- 6.0 mm). The height of excision (RR 1.95, 95% CI 1.02, 3.76; P = .04) and a totally endocervical lesion (RR 5.07, 95% CI 1.96, 14.44; P = .001) were the only independent factors associated with postoperative stenosis identified by a multivariate analysis using logistic regression.
The height of excision and a totally endocervical lesion were the main factors associated with cervical stenosis. The decreased risk associated with the loop electrosurgical excision procedure seems to be due to a shorter endocervical excision.
评估接受激光锥切术或环形电切术治疗的患者中宫颈狭窄的发生率，并确定与其发生相关的术前及治疗因素。
对255例行激光锥切术治疗的女性和277例行环形电切术治疗的女性分别进行术后阴道镜定期随访，平均随访时间分别为38个月和16个月。宫颈狭窄定义为宫颈管狭窄，无法插入2.5mm的海格扩张器。
治疗后长达28个月共诊断出38例宫颈狭窄病例，其中7例为完全性狭窄。50岁以上患者术后发生宫颈狭窄的风险更高（相对危险度[RR] 3.07，95%置信区间[95%CI] 1.30，7.26；P = 0.031），宫颈管内完全病变的患者（RR 3.79，95%CI 1.88，7.62；P = 0.001），切除高度达20mm及以上的患者（RR 2.96，95%CI 1.63，5.38；P = 0.005），以及接受激光锥切术的患者（RR 2.35，95%CI 1.24，4.46；P = 0.009）。产次、绝经状态、既往宫颈上皮内瘤变治疗史、满意的阴道镜检查、病变大小、组织学诊断及切除范围均未增加宫颈狭窄风险。环形电切术的切除高度低于激光锥切术（14.3±5.0mm对20.2±6.0mm）。切除高度（RR 1.95，95%CI 1.02，3.76；P = 0.04）和宫颈管内完全病变（RR 5.07，95%CI 1.96，14.44；P = 0.001）是经逻辑回归多因素分析确定的与术后狭窄相关的仅有的独立因素。
切除高度和宫颈管内完全病变是与宫颈狭窄相关的主要因素。环形电切术相关风险降低似乎是由于宫颈管内切除较短。
