| Objective: To compare the effects of circular suture and sturmdorf suture on cervical length in cervical conization,to explore the suitable suture method for cervical intraepithelial neoplasia patients with reproductive requirements.Methods: 54 patients with CIN II-III underwent conization in the Second Hospital of Hebei Medical University from May 2019 to June2020,aged ≤40 years,were followed up for 6 months after operation,and were divided into experimental group(18 cases)and control group(36cases)according to the suture method of 1:2.The main outcome indicator of observation is the cervical length 6 months after operation(the measurement method of cervical length: the distance from the internal cervix to the external cervix is measured by transvaginal ultrasound,the sonographers have more than 3 years’ qualifications,the measurement of cervical length is standardized and trained,each patient measures at least3 times,the minimum value is the measured value of cervical length).Secondary outcome indicators were operation time,intraoperative blood loss and cervical morphology 6 months after operation(evaluation criteria of cervical morphology: whether the scale-column junction is visible,whether the diameter of cervical orifice is normal,whether the shape of cervix is regular and whether the anatomy of cervix returns to normal).Results: The median length of cervix before operation was31.10(32.95-28.72)mm,the median length of cervix after operation was27.25(30.13-25.63)mm,the median shortened length of cervix was 2.8(5.45-1.93)mm.In the control group,the median cervical length was31.30(34.38-27.40)mm before operation,25.25(28.33-21.23)mm after operation and 4.3(10.385-11.93)mm after operation.There was no significant difference in cervical length between the two groups before operation,but there was significant difference in cervical shortening length after operation(P = 0.039,P<0.05).The operation time of the experimental group was 36.28±11.99 min,while that of the control group was 40.75±13.58 min,P=0.88(P < 0.05),with no significant difference.The median blood loss during operation was 20(10-30)ml in the experimental group and 20(10-30)ml in the control group,P=0.844(P<0.05),with no significant difference.After 6 months follow-up,it was more common in the experimental group than in the control group that the cervical scale-column junction was visible,the diameter of cervix was normal,the shape of cervix was regular,and the anatomy of cervix recovered to normal.Conclusion: Compared with sturmdorf suture,cervical circular suture has less influence on cervical length.For CIN patients with fertility requirements,cervical circular suture can be considered to reduce the incidence of adverse pregnancy outcomes in the future.Objective: To analyze the relationship between cervical length and premature delivery outcome by evaluating the change of cervical length in the second trimester of pregnancy after cervical conization.Methods: Design: Meta analysis.Data source:Pub Med 、 The Cochrane Library、OVID、CNKI、VIP、Wan Fang Data and CBM database.Data extraction and synthesis: The researchers independently extracted the data and evaluated the quality of the literature using Mewcastle-Ottawa Scale standard,verified the inclusion and exclusion criteria.Classify the research according to different outcome indicators.Using I2 statistical data to evaluate heterogeneity among studies.Outcome indicators: cervical length,perinatal mortality,premature birth,low birth weight,premature rupture of membranes before term.Results: 7 studies were included.The results showed that the average cervical length of women with a history of cervical conization in the second trimester of pregnancy was shorter than that without a history of cervical conization(MD-4.41,95% CI-8.54 to-0.27).The proportion of cervical length less than<30mm increased(RR 2.99,95% CI 1.02-8.75),the difference was statistically significant.The relative risk of delivery after 37 weeks was 1.84(95% CI 0.57-5.97),and that after 34 weeks was 3.36(95% CI 0.7-16.24),the difference was statistically significant.There was no significant difference between the proportion of cervical length<25mm and<15mm.When the average cervical length in the second trimester of pregnancy after conization is 34.2mm(MD-4.41,95% CI-8.54 to-0.27),the rate of delivery less than 37 weeks is 16.86%(RR 6.97,95% CI 2.52-19.28),the rate of delivery<34 weeks is 5.04%.Conclusion: After cervical conization,the length of cervix in the second trimester of pregnancy is shortened and the rate of premature birth is increased.When the average length of cervix in the second trimester of pregnancy is 34.2mm,the risk of premature birth<37 weeks is obviously increased,so obstetric management should be strengthened for these patients. |
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