摘要
目的 探讨宫颈环形电切术 (LEEP)治疗宫颈上皮内瘤变 (CIN)的效果以及宫颈标本边缘受累与否与预后的关系。方法 采用阴道镜辅助下的宫颈环形电切术 ,对 135例CIN患者进行治疗并对其疗效进行回顾性分析。结果 本研究中 ,患者中位年龄为 42岁 (18～ 6 7岁 ) ,中位妊娠次数2 2次 (0～ 8次 )。根据宫颈细胞学涂片检查结果 ,诊断为重度鳞状上皮内瘤变 (HGSIL)占 6 5 9% ,阴道镜诊断亦与上述结果类似 (75 6 % )。LEEP术后病理检查结果阴性者 7例 (5 2 % ) ;人乳头状瘤病毒(HPV)感染者 2例 (1 5 % ) ;CINⅠ级 (CINⅠ ) 15例 (11 1% ) ;HGSIL 10 8例 (80 0 % ) ,其中CINⅡ级 (CINⅡ ) 2 0例 (14 8% ) ,CINⅢ级 (CINⅢ ) 88例 (6 5 2 % ) ;宫颈微小浸润癌 3例 (2 2 % )。 78例 (5 7 8% )宫颈标本边缘病理学检查未见CIN病变 ;5 7例 (4 2 2 % )宫颈标本边缘CIN病变检测阳性或不能确定 (指由于电灼对细胞的破坏 ,影响了LEEP术后标本边缘的病理诊断 ) ,其中HGSIL 5 4例 (94 7% )。在 2 1例(15 6 % )宫颈标本边缘CIN病变检测阳性和 36例 (2 6 7% )宫颈标本边缘病理学检查不能确定患者中 ,CIN病变残留患者分别为 1例 (4 8% )和 3例 (8 3% ) ,复发患者分别为 1例 (4 8% )和 2例(5 6 % ) ;而在 78例宫颈?
Objective To determine the effectiveness and safety of loop electrosurgical excision procedure (LEEP) for the management of cervical intraepithelial neoplasia (CIN) and the significance of positive margins in cervical cone biopsy specimens with the relationship of prognosis. Methods LEEP under local anesthesia and colposcopic guidance was performed in an outpatient of colposcopic clinic. Records of 135 patients treated between Feb 1992 and Jul 1999 were reviewed prospectively. Results The median age of patients in this study was 42 years (range 18～67 years), parity 2 2 times (range 0～8 times). High grade squamous intraepithelial lesion (HGSIL) accounted for majority of diagnosis according to pap smear (65 9%) and colposcopy (75 6%) respectively. The results of LEEP demonstrated negative histology in 7 patients (5 2%), human papilloma virus (HPV) infection in 2 patients (1 5%), CINⅠ in 15 patients (11 1%), HGSIL in 108 patients (80 0%) which including 20 patients (14 8%) of CINⅡ , 88 patients (65 2%) of CINⅢ , microinvasion in 3 patients (2 2%). Clear resection margin of lesion in cervix was noted in 78 (57 8%) patients. Unclear margins were appeared in 57 (42 2%) patients including 21 cases (15 6%) of resection margin positive and 36 cases(26 7%) of resection margin undetermined. HGSIL accounted for the majority (54 cases, 94 7%) in this kind of patients. The residual CIN occurred in 1 patient (4 8%) with the resection margin positive and 3 patients(8 3%) with the resection margin undetermined respectively. In 2 patients (2 6%) with the resection margin clear. Recurrence CIN occurred in 1 patient (4 8%) with the resection margin positive and 2 patients(5 6%) with the resection margin undetermined respectively, none of the patients (0 0%) with the resection margin clear. The overall cure rate in this study was 93 3% after first LEEP done. The residual CIN was identified in 6 (4 4%) patients. The recurrence CIN occurred in 3 (2 2%) patients. Complications of LEEP occurred in 14 1% (19/135) patients in this study. Conclusions LEEP is a kind of effective and safe method for the treatment of cervical intraepithelial neoplasia. The status of resection margin should be concerned. Margin involvement of specimen is the risk factor for residual and recurrence of CIN.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2001年第5期271-274,共4页
Chinese Journal of Obstetrics and Gynecology
关键词
电外科手术
子宫颈上皮内瘤样病变
手术中并发症
局部肿瘤复发
Electrosurgery
Cervical intraepithelial neoplasia
Intraoperative complications
Neoplasm recurrence, local
