宫颈LEEP术与CKC术后宫颈再生对比研究

林毅 徐琼飞 王宁宁

[摘要] 目的 对比分析宫颈环形电切和宫颈冷刀锥切的术后宫颈再生情况。对有生育要求的高级别宫颈鳞状上皮内瘤变患者在临床上给予最佳手术方式及指导手术与妊娠间隔时间。 方法 收集2017年9月至2018年9月因HSIL在本院住院手术的患者100例，随机分为LEEP组（n=50）和CKC组（n=50）。对符合纳入标准的患者进行术前、术后1年内宫颈相关数据的阴道超声测量。获得术前、术后宫颈长度及宫颈体积的变化数据，以了解宫颈再生情况。 结果 两种术式术后3个月内宫颈的形态均可恢复正常;LEEP组术后第6个月宫颈长度及体积可恢复至术前的89.03%，差异有统计学意义（P<0.05），之后宫颈长度及体积再无明显改变;CKC组术后第9个月宫颈长度及体积可恢复至术前的88.82%，差异有统计学意义（P<0.05），之后宫颈长度及体积再无明显改变;LEEP组和CKC组术后完成宫颈再生后，最终长度及体积比较，差异无统计学意义（P>0.05）。 结论 两种方法术后宫颈再生稳定期时间有差异，如手术适应证允许，建议有生育要求的患者选择LEEP手术治疗，术后6个月再计划怀孕，不适合LEEP而行CKC手术的患者可在术后9个月再计划怀孕，以降低流产、早产等不良妊娠结局风险。

[关键词] 高级别宫颈鳞状上皮内瘤变;宫颈环形电切术;宫颈冷刀锥切术;宫颈再生;妊娠

[中圖分类号] R713.4          [文献标识码] B          [文章编号] 1673-9701（2021）30-0001-05

[Abstract] Objective To compare and analyze the regenerative status of the cervix after cervical circular electric resection and cervical cold knife conization， and to provide the best operation method and operation guidance and the pregnancy interval for patients with high-grade cervical squamous intraepithelial neoplasia with fertility requirements. Methods A total of 100 patients who were hospitalized for HSIL surgery in our hospital from September 2017 to September 2018 were collected and randomly divided into LEEP group （n=50） and CKC group （n=50）. Standardized vaginal ultrasound measurement of cervical-related data was performed for all patients meeting the inclusion criteria before surgery and within one year after surgery. The relationship between changes in cervical length and cervical volume before and after surgery was analyzed to obtain cervical regeneration. Results The morphology of the cervix can be restored entirely within three months after cervical conization. The length and volume of the cervix in the LEEP group six months after the operation can be restored to 89.03% before surgery， and the difference was statistically significant （P<0.05）. After that， the length and volume of the cervix did not change significantly; the size and volume of the cervix in the CKC group at the 9th month after surgery could be restored to 88.82% of the preoperative value， and the difference was statistically significant（P<0.05）. The length and volume of the cervix had no longer considerable changes afterward. After cervical regeneration was completed after surgery in the LEEP group and the CKC group， there was no significant difference in the final length and volume （P>0.05）. Conclusion There is a difference in the stable period of cervical regeneration after the two methods. If surgical indications allow，LEEP surgery is recommended for patients with fertility requirements， and pregnancy is planned for six months after surgery. If the patient is not suitable for LEEP surgery， you can arrange to get pregnant again nine months after cervical cold knife conization， to reduce the risk of miscarriage， premature birth， and other adverse pregnancy outcomes caused by insufficient cervical regeneration.

[Key words] High-grade cervical squamous intraepithelial neoplasia; Cervix circular resection; Cervical cold knife conization; Cervical regeneration; Pregnancy

宫颈癌是发生在宫颈部位的一种恶性肿瘤，全球每年的宫颈癌新发人数约50万，死亡人数约25万[1]。宫颈上皮内瘤变（Cervical intraepithelial neoplasia，CIN）是宫颈癌的癌前病变。……