子宫颈环形电切术治疗子宫颈上皮内瘤变83例疗效分析

目的:探讨子宫颈环形电切术(LEEP)在诊治不同级别子宫颈上皮内瘤变(CIN)的效果、术后并发症及其预防措施和手术后标本的观察处理原则.方法:对妇科检查、细胞学、阴道镜活检初步诊断为CIN各期患者83例,采用环形电刀行子宫颈椎切术.观察手术前后组织病理诊断结果变化,对其疗效作回顾性分析.结果:术前、术后病理诊断一致57.8%;术后病理诊断级别下降37.4%,其中下降一级22.9%,下降两级12.1%,下降三级2.4%;术后病理诊断级别上升4.8%,其中上升一级3.6%,上升两级占1.2%.手术切缘阳性2例,其中CIN2、3各1例.术后3个月细胞学检查为CIN2 1例,其余均正常.术后子宫颈管解剖狭窄2例,术后2周大量出血1例.术后半年无CIN 81例,治愈率97.6%;子宫颈CIN残留2例;第1年内复查发现CIN 2持续1例.结论:LEEP是一种诊断、治疗CIN的较为理想的手段,只要掌握手术指征,规范手术步骤,注意术后病理观察,可获得满意疗效.

The effects of loop electrosurgical excision procedure on 83 patients with cerical intraepithelial neoplasia

Objective:To explore the effects of loop electrosurgical excision procedure(LEEP) on cervical intraepithelial neoplasia(CIN) and prevent the postoperative complications and observe treatment principles for postoperarion specimens.Methods:Eighty-three patients with CIN were dignosed by gynecological check-up,cytology and vaginoscope biopsy,and operated with LEEP.The results of pathology diagnosis were compared before and after operation,and the curative effects were retrospectively analyzed.Results:The concordance rates of pathologic diagnosis were 57.8% before and after operation.The rates of descent of postoperative pathologic diagnosis were 37.4%,including dropping one grade in 22.9%,two grade in 12.1% and three grade in 2.4%.The rates of ascend of postoperative pathologic diagnosis were 4.8%,including rising one grade in 3.6%,two grade in 1.2%.Operation cut margin of 2 cases was postive reaction,including 1 case of CIN2 and 1 case of CIN3.Three months after operation,the results of cytology demonstrated CIN2 in 1 case,others were normal.The cervical stenosis in 2 cases at postoperation and massive haemorrhage in 1 case 2 weeks postoperation were found.No cases showed CIN for half year postoperation.The cure rates were 97.6%,and residual CIN in cervix were 2 cases.One 1 case of CIN2 were found after 1 year.Conclusions:LEEP is a ideal means in diagnosis and treatment of CIN.Mastering surgical indications,regulating surgical procedure and pay attention to the postoperative pathologic observation can obtain satisfied results.