最近，丹麦哥本哈根大学Mathias Aagaard团队研究了宫颈锥切术的并发症，及其对生育能力和宫颈狭窄的影响。相关论文于2025年1月15日发表在《英国医学杂志》上。

为了评估宫颈锥切术的并发症及其对生育能力和宫颈狭窄的影响，研究组使用几个链接数据库对常规收集的数据进行基于注册的全国性队列研究，包括2006-2018年丹麦的初级和二级保健机构。

锥切队列包括48048例对23-65岁女性的锥切术，这些女性在宫颈活检后120天内接受了锥切。活检队列包括48048例对接受过宫颈活检但未接受锥切术的女性进行的活检，这些女性的年龄和手术时间相匹配。在进行长期结果分析之前，如果女性在锥切术前10年内进行了子宫切除术或患有宫颈癌症或任何长期结果，则将其排除在锥切术队列之外。

主要结局为锥切术后30天内出血、感染和妇科手术（按年龄、锥切年份和既往锥切次数分层）以及锥切后任何时候的长期生育治疗、生育咨询、宫颈狭窄、宫颈扩张、不孕诊断和死亡风险。对长期结局进行随访，直到死亡、移民、诊断为癌症宫颈癌或子宫切除术，或直到2018年底截止。根据Cox回归模型的发病率比率分析长期结果。

在手术后30天内，出血、感染和妇科手术分别占所有锥切手术的2.81%（n=1351）、0.48%（n=231）和3.95%（n=1897）。与活检队列中的女性相比，锥切队列中的妇女患宫颈狭窄（发病率比14.81，95%置信区间7.55至29.05，0.41%对0.03%（n=176 v 12））和宫颈扩张（2.68，2.41至2.97，4.01%对1.58%（n=1735 v 668））的风险增加。在调整基线协变量（如年龄和居住地区）时，其他结局没有显著差异。出血后缝合宫颈与狭窄和宫颈扩张的风险显著增加有关。

这项研究发现，与之前具有可比结果定义的研究相比，锥切术后30天内的并发症发生率更高，并且对于在锥切后进行宫颈缝合治疗出血的女性来说，宫颈狭窄和宫颈扩张的风险大大增加。然而，这些结果基于一个小分组中的少数事件，因此与主要的不确定性有关。这项研究支持了之前的发现，即锥切术通常不会增加不孕治疗或不孕诊断的发生率。

附：英文原文

Title: Short term complications of conisation and long term effects on fertility related outcomes in Denmark: register based nationwide cohort study

Author: Mathias Aagaard, Jessica á Rogvi, Frederikke Modin, Dagny Nicolaisdóttir, Volkert Siersma, John Brandt Brodersen

Issue&Volume: 2025/01/15

Abstract:

Objective To report on complications of conisation and its effects on fertility and stenosis.

Design Register based nationwide cohort study on routinely collected data using several linked databases.

Setting Primary and secondary care in Denmark, 2006-18.

Population The conisation cohort comprised 48048 conisations on women aged 23-65 who had undergone conisation within 120 days of a cervical biopsy. The biopsy cohort comprised 48048 biopsies on women who had undergone a cervical biopsy but not conisation who were matched by age and time of procedure. Women were excluded from the conisation cohort before long term outcome analyses if they had undergone hysterectomy, resection of the uterus, or had cervical cancer or any long term outcomes within the 10 years before their conisation.

Main outcome measures Bleeding, infection, and gynaecological operations within 30 days of conisation (stratified by age, year of conisation, and number of previous conisations) and long term risk of fertility treatment, fertility consultation, stenosis, cervical dilatation, infertility diagnoses, and death at any point after conisation. Long term outcomes were followed up until death, emigration, diagnosis of cervical cancer, hysterectomy or resection of uterus, or the end of 2018. Long term outcomes were analysed with incidence rate ratios from Cox regression models.

Results Bleeding, infection, and gynaecological operations were registered for 2.81% (n=1351), 0.48% (n=231), and 3.95% (n=1897) of all conisations within 30 days of the procedure, respectively. Women in the conisation cohort had increased risk of stenosis (incidence rate ratio 14.81, 95% confidence interval 7.55 to 29.05, 0.41% v 0.03% (n=176 v 12)) and cervical dilatation (2.68, 2.41 to 2.97, 4.01% v 1.58% (n=1735 v 668)) compared with women in the biopsy cohort. No significant differences were observed for the other outcomes when adjusting for baseline covariates (such as age and region of residence). Cervical suturing after bleeding was associated with a substantial increase in the risk of stenosis and cervical dilatation.

Conclusion This study found higher rates of complications within 30 days of conisation than previous studies with comparable outcome definitions, and a substantially increased risk of stenosis and cervical dilatation for women who had cervical suturing to treat bleeding after conisation. However, these results were based on few events in a small subgroup, and are therefore associated with major uncertainty. This study supports previous findings that conisation does not generally increase rates of infertility treatment or infertility diagnoses.

DOI: 10.1136/bmj-2023-078140

Source: https://www.bmj.com/content/388/bmj-2023-078140