探讨早、中孕期宫颈息肉摘除术对母儿妊娠结局的影响。

选择2012年1月至2018年4月，于中国医科大学附属盛京医院妇产科因妊娠合并宫颈息肉于早、中孕期接受宫颈息肉摘除术治疗的167例孕妇为研究对象。按照术后妊娠结局，将其分为自然流产组(自然流产时孕龄<28孕周，n＝17)，早产组(分娩时孕龄为28～36^＋6孕周，n＝48)和足月产组(分娩时孕龄≥37孕周，n＝102)3组。采用Kruskal-Wallis H秩和检验或者Mann-Whitney U秩和检验对年龄、孕次、产次等计量资料进行统计学分析。采用线性趋势χ²检验或者χ²检验对宫颈锥切术史者、妊娠期糖尿病者、合并妊娠高血压疾病者、术前阴道流血者所占比例等计数资料进行统计学分析。在上述单因素分析基础上，根据既往研究结果及临床经验，进一步进行有序多分类非条件logistic回归分析，对早、中孕期宫颈息肉摘除术后可能影响孕妇妊娠结局的相关因素进行分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求，并且与受试者本人及其家属签署临床研究知情同意书。

①自然流产组、早产组和足月产组孕妇的产次均为0，接受宫颈息肉摘除术时的孕龄，分别为13孕周(12～14孕周)、15孕周(13～17孕周)和15孕周(13～18孕周)；术后阴道流血发生率分别为35.3%(6/167)、50.0%(24/167)和48.0%(49/167)；手术时孕龄≤12孕周所占比例分别为23.5%(4/167)、10.4%(5/167)和5.9%(6/167)，3组的上述4项指标分别比较，差异均有统计学意义(χ²＝7.363、7.535、9.198、4.364，P＝0.025、0.023、0.002、0.037)。②结合目前已有研究结果及临床经验与本研究单因素分析结果中差异有统计学意义(P<0.05)因素，对早、中孕期宫颈息肉摘除术后，可能影响孕妇妊娠结局因素的研究结果显示，孕妇接受息肉摘除术后无阴道流血，是足月产分娩的保护因素(OR＝13.577，95%CI：1.300～141.743，P＝0.029)。③宫颈息肉和宫颈蜕膜息肉孕妇的晚孕期自然流产发生率分别为37.3%(56/150)和76.5%(13/17)，合并息肉炎症反应发生率分别为52.7%(79/150)和0，二者分别比较，差异均有统计学意义(χ²＝9.646、16.991，P＝0.002、<0.001)。

妊娠合并宫颈息肉孕妇接受宫颈息肉摘除术治疗，应避免于孕龄<12孕周前进行，术中应采取最适合的止血措施。病理学类型为宫颈蜕膜息肉孕妇，对早、中孕期接受宫颈息肉摘除术不会增加自然流产风险，但是宫颈蜕膜息肉孕妇，较普通宫颈息肉者更易发生晚孕期自然流产。

To explore pregnancy outcomes and influencing factors of pregnant women undergoing cervical polypectomy during the first and second trimester.

From January 2012 to April 2018, a total of 167 pregnant women with single-pregnancy who were operated by cervical polypectomy during first and second trimester in Shengjing Hospital of China Medical University were collected in this study. According to pregnancy outcomes, they were divided into 3 groups: miscarriage group (gestational age at termination of pregnancy < 28 gestational weeks, n=17), premature group (gestational age at termination of pregnancy was 28-36^{+ 6} gestational weeks, n=48) and full-term group (gestational age at termination of pregnancy ≥37 gestational weeks, n=102). The Kruskal-Wallis H rank sum test or Mann-Whitney U rank sum test were used to carry out statistical analysis on the quantitative data such as age, pregnancy and parity. Linear trend chi-square test or chi-square test were used to statistically analyze the counting data, such as the proportion of patients with cervical conization history, gestational diabetes mellitus, pregnancy-induced hypertension and preoperative vaginal bleeding. On the basis of the above single factor analysis, according to previous research results and clinical experience, further orderly multi-classification unconditional logistic regression analysis was carried out to analyze the relevant factors that may affect the pregnancy outcomes of patients after cervical polypectomy during the first and second trimester. This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013. All participants confirmed and signed consent forms for clinical trials.

① There were 0 (0-0), 0 (0-1) and 0 (0-0) parity in miscarriage group, preterm group and full-term group, respectively. The gestational age at the time of operation was 13 weeks (12-14 weeks), 15 weeks (13-17 weeks) and 15 weeks (13-18 weeks), respectively. The proportion of vaginal bleeding after operation was 35.3% (6/167), 50.0% (24/167) and 48.0% (49/167), and the proportion of gestational age ≤ 12 weeks at the time of operation was 23.5% (4/167), 10.4% (5/167) and 5.9% (6/167), respectively. The differences among the above four indexes were statistically significant (χ² =7.363, 7.535, 9.198, 4.364; P=0.025, 0.023, 0.002, 0.037). ② Combined with the existing research results and clinical experience, as well as the factors with statistically significant difference in single factor analysis results (P< 0.05), the orderly multivariate unconditional logistic regression analysis was conducted. The results showed that no vaginal bleeding after polypectomy was the protective factor for full-term delivery (OR=13.577, 95%CI: 1.300-141.743, P=0.029). ③The rate of spontaneous abortion in third trimester was 37.3% and 76.5% in patients with cervical polyp and decidual polyp, and the rate of patients with polyp inflammation was 52.7% and 0, respectively. The differences were statistically significant (χ²=9.646, 16.991, P=0.002, <0.001).

Cervical polypectomy in pregnancy should be avoided before 12 gestational weeks and hemostasis measures should be taken during operation. However, patients with cervical decidual polyps are more likely to have spontaneous miscarriage in third trimester than those with cervical polyps.