高频电波刀环型电切除术治疗306例宫颈上皮内瘤变的临床价值

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。

Loop electrosurgical excision procedure in treatment of cervical intraepithelial neoplasia: an experience with 306 cases

Objective To assess the clinical value of loop electrosurgical excision procedure in treating cervi- cal intraepithelial neoplasia(CIN).Methods A total of CIN 306 patients preliminarily diagnosed by cervical cyto- logical examination,colposeopy,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 post- operative 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 sub- total 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 1.4%.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)