LEEP术对绝经后妇女高级别宫颈上皮内瘤变的诊治

目的:探讨绝经后妇女高级别宫颈上皮内瘤变行宫颈环形电切术(LEEP)诊治的临床价值。方法:选择2017年2月-2018年12月于北京妇产医院妇科微创中心因宫颈高级别鳞状上皮内病变(HSIL)行LEEP术的患者共142例,其中绝经组40例,未绝经组102例。收集2组患者的液基薄层细胞学检查(TCT)、高危型人乳头瘤病毒(HPV)检测、阴道镜检查及其活检病理结果、LEEP术后病理结果、切缘病变情况,并将上述检查结果进行组间比较。结果:2组患者阴道镜下宫颈转化区类型比较,差异有统计学意义(χ~2=28.658,P=0.000)。绝经组阴道镜活检与LEEP术后病理符合率为50.00%(20/40),未绝经组符合率为51.96%(53/102),2组差异无统计学意义(χ~2=0.044,P=0.854)。绝经组1例LEEP术后病理升级为宫颈癌,未绝经组1例LEEP术后病理升级为原位腺癌。绝经组术后病理切缘阳性8例(20.00%),未绝经组术后病理切缘阳性16例(15.69%),2组比较差异无统计学意义(χ~2=0.381,P=0.537)。2组患者术后TCT检查比较及高危型HPV感染情况比较,差异均无统计学意义(均P>0.05)。结论:LEEP手术适用于宫颈无明显萎缩的绝经后妇女高级别宫颈上皮内瘤变的诊治,以避免对宫颈病变的漏诊和过度治疗。

Diagnosis and Treatment of LEEP for High-Grade Cervical Squamous Intraepithelial Lesions in Postmenopausal Women

Objective: To investigate the clinical value of loop electrosurgical excision procedure(LEEP) in the diagnosis and treatment of high-grade cervical squamous intraepithelial lesions in postmenopausal women. Methods: 142 patients with high-grade squamous intraepithelial lesion(HSIL) who underwent LEEP in Department of Gynecology Minimal Invasive Center of Beijing Obstetrics and Gynecology Hospital from February 2017 to December 2018 were collected,including 40 patients in postmenopausal group, 102 patients in premenopausal group. All results of patients′ thinprep cytologic test(TCT), human papilloma virus(HPV) test,colposcopy and biopsy pathology, postoperative pathological examination and pathological examination of incision margin were collected. The data were compared between the two groups. Results: The difference of the cervical transformation zone type under colposcopy was significant between the two groups(χ~2=28.658,P =0.000). The consistence rate of pathology between colposcopic biopsies and post-LEEP was 50.00%(20/40) in the group of postmenopausal women, and that in the group of premenopausal women was 51.96%(53/102). There was no statistical difference between the two groups( χ~2=0.044, P =0.854). In the group of postmenopausal women, 1 case of the pathological examination results after LEEP was escalated to cervical cancer. In the group of premenopausal women 1 case was escalated to cervical adenocarcinoma in situ. 8 cases′ surgical margins were positive in the group of postmenopausal women. The cases with positive surgical margins were 16 in the group of premenopausal women. The difference was not significant( χ~2=0.381, P=0.537). The difference of the results of TCT and HPV test after LEEP in the two groups was not significant(P>0.05). Conclusions: LEEP is suitable for the diagnosis and treatment of HSIL in postmenopausal women without obvious cervical atrophy. It helps to avoid missed diagnosis and overtreatment.