摘要
目的探讨高频电波刀环型电切除术(LEEP)治疗宫颈上皮内瘤变(CIN)的临床价值。方法经宫颈细胞学、阴道镜及宫颈活检检查初步诊断为CIN的门诊患者306例,在阴道镜辅助下行LEEP手术治疗,切除标本均送病理学检查并行人乳头状瘤病毒(HPV)-16、18检测,同时观察手术时间、出血量及术后疗效。结果中位手术时间为7min,中位出血量为7mL。术前与术后病理结果一致占78.1%(239/306例),病理结果不一致占21.9%(67/306例)。级别下降占14.7%(45/306例);级别上升占7.2%(22/306例),其中4例为宫颈早期浸润癌,行次广泛子宫切除术,术后病理均得以证实。4例病变持续存在者及4例病变复发者均为HPV-16和(或) HPV-18型感染,其中6例行再次LEEP手术治疗。术后并发症发生率为8.0%,一次性治愈率达97.2%,复发率为1.4%。结论LEEP治疗CIN具有手术时间短、出血少、术后并发症少、治愈率高、可重复性、提供完整病理标本及诊治双重作用的优点,为一种治疗CIN的简单、安全和高效方法。对于HPV-16和(或)HPV-18型阳性者,术后应加强随访观察。
Objective To assess the clinical value of loop electrosurgical excision procedure in treating cervical intraepithelial neoplasia（CIN）. Methods A total of CIN 306 patients preliminarily diagnosed by cervical cytological examination, colposcopy, or cervical biopsy preliminarily were treated by LEEP under colposcope. The specimens were sent for pathological diagnosis and HPV 16/18 test. The operation time, the blood loss, and postoperative outcomes were observed. Results The median operation time was 7 min and the average blood loss was 7 mL. The preoperative pathological diagnoses of 239 cases（78.1 %） were consistent with that of the postoperative ones; and 67 cases（21.9%） were not consistent. The postoperative grade was lowered in 45（14.7%） cases and was elevated in 22 （7.2%） cases; among the elevated ones, 4 cases were early invasive carcinomas and received subtotal resection. All the 4 patients with continuous lesions and 4 with recurrence were positive of HPV 16/18. Six patients received a second time of LEEP; the postoperative complication rate was 8.0% ; the primary cure was achieved in 97. 2% of patients and the recurrence rate was 1.40%. Conclusion The advantages of LEEP include short operation time, less blood loss, less complication, high curative rate, good repeatability, etc. LEEP is a simple, safe, and effective method for treatment of CIN. Enhanced follow up should be given to patients positive of HPV-16 or 18. （Shanghai Med J, 2007, 30：831-833）
出处
《上海医学》
CAS
CSCD
北大核心
2007年第11期831-833,共3页
Shanghai Medical Journal
关键词
宫颈环型电切除术
宫颈上皮内瘤变
治疗
Loop electrosurgical excision procedure
Cervical intraepithelial neoplasia
Treatment
