High risk factors and preventive measures of cervical adhesion caused by loop electrosurgical excision procedure

doi:10.3877/cma.j.issn.1673-5250.2016.04.008

Objective

To investigate the high risk factors of cervical adhesion caused by loop electrosurgical excision procedure (LEEP), and to find out the effective measures to prevent cervical adhesion caused by LEEP.

Methods

From January 2013 to December 2014, a total of 603 cases of menopausal transition and postmenopausal patients who received LEEP treatment in International Peace Maternity & Child Health Hospital of China Welfare Institute with taking cervical adhesion prevention measures after LEEP were enrolled into study group. From January 2003 to December 2012, a total of 10 863 cases of patients who received LEEP treatment in International Peace Maternity & Child Health Hospital of China Welfare Institute without taking cervical adhesion prevention measures after LEEP were enrolled into non-intervention group. According to the different cervical adhesion prevention measures after LEEP in study group: placing intrauterine device (IUD) which was T type ring with tail wire once after the treatment of LEEP or using Hegar cervical dilator for physical cervical dilatation, the menopausal transition and postmenopausal patients in study group were further divided into IUD subgroup (n=144) and physical dilator subgroup (n=459). And in the non-intervention group, the menopausal transition and postmenopausal women were included into control group (n=2 270). The incidence of cervical adhesion caused by LEEP in non-intervention group and the related risk factors of cervical adhesion caused by LEEP were analyzed by retrospective analysis method. By following up the study group, the effects of cervical adhesion intervention measures were analyzed prospectively. The incidences of cervical adhesion caused by LEEP in study group and control group, and the incidences of cervical adhesion caused by LEEP and genital tract infection in IUD subgroup and physical dilator subgroup were statistically compared to evaluate the effects of the cervical adhesion intervention measures. There were no statistical differences between the study group and control group, IUD subgroup and physical dilator subgroup in the basic data such as age, gravidity and parity, ratio of type of disease, mode of delivery and so on (P>0.05).

Results

①The incidence of cervical adhesion caused by LEEP in non-intervention group was 9.6% (1 042/10 863). In non-intervention group, the incidences of cervical adhesion caused by LEEP in the patients with menopausal transition and menopause, previous cesarean section delivery and conization depth >10 mm were obviously higher than those in the patients with mature period, the previous vaginal delivery, conization depth < 10 mm, respectively, and all the differences were statistically significant (χ²=3 692.23, P<0.001; χ²=5.11, P=0.024; χ²=15.72, P<0.002). There were no statistical differences among the incidences of cervical adhesion caused by LEEP in patients with different gravidity and parity in non-intervention group (P>0.05). ②The incidence of cervical adhesion caused by LEEP in study group was 10.6% (64/603), which was significantly lower than that in control group (43.8%, 995/2 270), and the difference was statistically significant (χ²=225.90, P<0.001). The incidences of cervical adhesion caused by LEEP in IUD subgroup and physical dilator subgroup were 18.1% (26/144) and 8.3% (38/459), respectively, and they were both obviously lower than that in control group, and both the differences were statistically significant (χ²=36.87, P<0.001; χ²=205.16, P<0.001). The incidences of cervical adhesion caused by LEEP in physical dilator subgroup was obviously lower than that in IUD subgroup, and the difference was statistically significant (χ²=11.04, P<0.001). ③In IUD subgroup, the expulsion rate of IUD was 41.0% (59/144). The genital tract infection rate in IUD subgroup was 24.3% (35/144), which was significantly higher than that in physical expansion subgroup (8.5%, 39/459), and the difference was statistically significant (χ²=25.45, P<0.001).

Conclusions

The three high risk factors of cervical adhesion caused by LEEP are menopause, delivery mode and conization depth. Both IUD and Hegar cervical dilator can significantly reduce the incidence of cervical adhesion caused by LEEP, but physical dilator method is better and more effective than IUD, and IUD is easy to fall off and the genital tract infection rate is higher than physical dilator method, so physical dilatation of the cervix is a more economical and effective method for the prevention of cervical adhesion after LEEP.

Key words: Cervix uteri, Cervical intraepithelial neoplasia, Loop electrosurgical excision procedure, Cervical adhesion, Program evaluation

表1 未干预组不同临床特征患者宫颈环形电切术治疗后的宫颈黏连发生率比较[例数(%)]

影响因素		例数	宫颈黏连发生率	χ²值	P值
月经情况		10 863	?	3 692.23	<0.001
?	绝经过渡期及绝经后期	2 270	995(43.8)	?	?
?	性成熟期	8 593	47(0.5)	?	?
孕次(次)		10 863	?	3.54	0.059
?	≤3	5 888	536(9.1)	?	?
?	>3	4 975	506(10.2)	?	?
产次(次)		10 863	?	2.19	0.139
?	≤1	10 396	988(9.5)	?	?
?	>1	467	54(11.6)	?	?
前次分娩方式		10 646^a	?	5.11	0.024
?	经阴道分娩	5 164	460(8.9)	?	?
?	剖宫产分娩	5 482	559(10.2)	?	?
宫颈锥切深度(mm)		10 863	?	15.72	<0.002
?	≤10	406	16(3.9)	?	?
?	>10～15	3 852	374(9.7)	?	?
?	>15～20	4 958	486(9.8)	?	?
?	>20	1 647	166(10.1)	?	?

表1 未干预组不同临床特征患者宫颈环形电切术治疗后的宫颈黏连发生率比较[例数(%)]

影响因素		例数	宫颈黏连发生率	χ²值	P值
月经情况		10 863	?	3 692.23	<0.001
?	绝经过渡期及绝经后期	2 270	995(43.8)	?	?
?	性成熟期	8 593	47(0.5)	?	?
孕次(次)		10 863	?	3.54	0.059
?	≤3	5 888	536(9.1)	?	?
?	>3	4 975	506(10.2)	?	?
产次(次)		10 863	?	2.19	0.139
?	≤1	10 396	988(9.5)	?	?
?	>1	467	54(11.6)	?	?
前次分娩方式		10 646^a	?	5.11	0.024
?	经阴道分娩	5 164	460(8.9)	?	?
?	剖宫产分娩	5 482	559(10.2)	?	?
宫颈锥切深度(mm)		10 863	?	15.72	<0.002
?	≤10	406	16(3.9)	?	?
?	>10～15	3 852	374(9.7)	?	?
?	>15～20	4 958	486(9.8)	?	?
?	>20	1 647	166(10.1)	?	?

表2 研究组与对照组宫颈环形电切术治疗后的宫颈黏连发生率比较[例数(%)]

组别		例数	宫颈黏连发生率
研究组		603	64(10.6)
?	放置IUD亚组	144	26(18.1)
?	物理扩张亚组	459	38(8.3)
对照组		2 270	995(43.8)
χ²值^a		?	225.90
P值		?	<0.001

表2 研究组与对照组宫颈环形电切术治疗后的宫颈黏连发生率比较[例数(%)]

组别		例数	宫颈黏连发生率
研究组		603	64(10.6)
?	放置IUD亚组	144	26(18.1)
?	物理扩张亚组	459	38(8.3)
对照组		2 270	995(43.8)
χ²值^a		?	225.90
P值		?	<0.001

表3 放置IUD亚组与物理扩张亚组生殖道感染率比较[例数(%)]

组别	例数	生殖道感染率
放置IUD亚组	144	35(24.3)
物理扩张亚组	459	39(8.5)
χ²值	?	25.45
P值	?	<0.001

表3 放置IUD亚组与物理扩张亚组生殖道感染率比较[例数(%)]

组别	例数	生殖道感染率
放置IUD亚组	144	35(24.3)
物理扩张亚组	459	39(8.5)
χ²值	?	25.45
P值	?	<0.001

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