宫颈上皮内瘤变治疗后生育及流产发生率的队列研究

Fertility and Miscarriage Incidence After Cervical Intraepithelial Neoplasia Treatment by Thermal Ablation: A Cohort Study

BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY

影响因子:4.3

分区:医学2区 Top / 妇产科学1区

发表日期:2025 Jan

作者: Ania Wisniak, Virginie Yakam, Sophie Evina Bolo, Alida Moukam, Jessica Sormani, Pierre Vassilakos, Bruno Kenfack, Patrick Petignat

DOI: 10.1111/1471-0528.17954

摘要

旨在评估热消融（TA）治疗宫颈异常增生对妇女生育和妊娠结局的影响，研究对象为喀麦隆宫颈癌筛查中筛查妇女。采用回顾性队列研究方法。地点为喀麦隆Dschang卫生区。参与者为2015年至2020年间在Dschang地区医院进行宫颈癌筛查的30-45岁妇女。主要通过人乳头瘤病毒（HPV）检测筛查，视察结果进行分诊，必要时采用TA治疗。2021年10月至2022年3月，进行随访访谈，收集接受热消融治疗和未治疗妇女的后续生育情况。研究内容为妊娠及流产情况。共有760名参与者完成调查（其中治疗组219人，未治疗组541人），平均随访时间为1297天。治疗组中有62名（28.3%）妇女报告怀孕，对照组为165名（30.5%）（p=0.550）。调整潜在混杂因素后，治疗妇女的怀孕风险比（HR）为0.82（0.54-1.24，p=0.350）。在已知结局且未自主终止的妊娠中，治疗组有18例（35.3%）发生流产，对照组为31例（21.4%）（p=0.048）。在调整模型中，热消融与流产之间不再具有统计学关联（OR=1.04，0.39-2.78，p=0.935）。在我们的研究人群中，热消融对生育能力和流产风险无显著影响。研究结果支持在低收入地区广泛采用热消融作为宫颈前癌病变的治疗手段。

Abstract

To assess the impact of thermal ablation (TA) for the treatment of cervical dysplasia on fertility and pregnancy outcomes among women screened for cervical cancer in Cameroon.Retrospective cohort study.Dschang health district, Cameroon.Participants aged 30-45 years from two screening trials conducted between 2015 and 2020 in Dschang District Hospital.Participants were primarily screened for human papillomavirus infection, triaged by visual inspection and treated by TA if needed. Between October 2021 and March 2022, interviews on subsequent fertility were conducted with participants treated by TA and a control group of untreated women.Pregnancy and miscarriage after screening/treatment.A total of 760 participants (219 treated and 541 untreated) completed the survey, with a mean follow-up time of 1297 days. Sixty-two women (28.3%) treated by TA reported a pregnancy postscreening versus 165 (30.5%) in the control group (p = 0.550). Adjusted for potential confounders, the hazard ratio of pregnancy for treated compared with untreated women was 0.82 (0.54-1.24, p = 0.350). Among women reporting pregnancies with a known outcome and which were not voluntarily terminated, 18 (35.3%) treated participants had a miscarriage versus 31 (21.4%) in the control group (p = 0.048). In the adjusted model, no association remained between TA and miscarriage (1.04, 0.39-2.78, p = 0.935).In our study population, TA did not significantly impact fertility nor miscarriage risk. Our results support the widespread use of TA as a treatment of choice for precancerous cervical lesions in low-income settings.