宫颈电环切除术后妊娠结局的临床相关研究

目的:探讨宫颈电环切除术对CIN患者术后妊娠结局的影响。方法:收集2000年至2007年因宫颈高度病变行LEEP术、术后成功受孕并已终止妊娠的妇女102例作为病例组。其中,按电切深度分为10～20mm组(76例)和21～25mm组(26例);按电切宽度分为15～20mm组(30例)和21～40mm组(72例)。随机抽取同期门诊无宫颈治疗史的健康孕产妇104例为对照组。追踪并比较各组自然流产率、早产率、胎膜早破率、低出生体重率以及剖宫产率。结果:病例组及对照组分娩孕周均>28周;两组自然流产率、早产率、胎膜早破率、剖宫产率和分娩孕周均无显著差异(P均>0.05);病例组新生儿平均体重显著高于对照组[(3.45±0.29)kg vs(3.32±0.35)kg,P<0.05]。宫颈电切深度为10～20mm组的妊娠结局与21～25mm组无显著差异(P>0.05);宫颈电切宽度为15～20mm组的妊娠结局与21～40mm组亦无显著差异(P>0.05)。结论:宫颈电环切除术对术后妊娠妇女的妊娠结局无明显影响。宫颈电环切除深度<25mm、宽度<40mm时,患者术后妊娠的自然流产、早产、胎膜早破、小于胎龄儿等不良结局发生率无明显增加。     

子宫颈电环切除术对203例宫颈上皮内瘤变的疗效研究

目的 探讨宫颈电环切除术(LEEP)手术方法和有关术后并发症的关系及其预防措施，手术后标本的观察处理原则。方法 1995年5月至2002年4月采用LEEP对203例宫颈上皮内瘤变(CIN)患者进行治疗，对其疗效作回顾性分析。结果 术前术后病理诊断一致占40．39％(82／203)；术后病理诊断级别下降占53．20％(108／203)，其中下降一级占25．62％，下降两级占19．2l％，下降三级占8．37％；术后病理诊断级别上升占6．4|D％(13／203)，其中上升一级占5．42％，上升两级占0．98％。宫颈管受累占5．9l％(12／203)。合并单纯子宫内膜增生过长占23．15％(47／203)。手术切缘阳性5例，其中CINI3例，CINⅡ、Ⅲ各l例。术后3个月细胞学检查为不典型鳞状上皮细胞占12．32％(25／203)，其余均为正常。术中出血达10mL仅2例，94．09％(190／203)的患者术后第2-18天出现少量阴道血性分泌物。术后子宫颈管解剖狭窄7例，术后盆腔痛16例。术后半年无CIN占193例。治愈率为95．07％；宫颈CIN残留5例，占2．46％；第1年内复查发现CINⅡ持续1例。术后妊娠20例次，足月阴道分娩4例，剖宫产同时绝育l例，7例现继续妊：娠已达中晚期。早期妊娠人工流产4例，宫外孕2例。早孕延期流产2例，未发现早产及低出生体重儿。结论 LEEP是治疗CIN的安全有效方法，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。     

宫颈环形电切术与子宫切除术的时间间隔对手术结局的影响

目的:评估宫颈环形电切术(LEEP)后行子宫切除术的时间间隔对手术结局的影响。方法:回顾分析2007～2013年在中山大学孙逸仙纪念医院妇瘤科行LEEP术后子宫切除或根治性子宫切除的186例患者的临床资料。根据LEEP术与行子宫切除术的时间间隔,将患者分为早期手术组(时间间隔≤4周)和延迟手术组(时间间隔4周)。分析LEEP术后再行子宫切除术间隔时间与手术结局的相关性。结果:186例中,LEEP术后行I型子宫切除术者117例,其中早期手术组55例,延迟手术组62例;LEEP术后行根治性子宫切除术者69例,其中早期手术组43例,延迟手术组26例。行I型子宫切除术和根治性子宫切除术患者中,早期手术组和延迟手术组的手术时间、失血、住院时间和手术并发症均无显著差异(P0.05)。LEEP术后接受广泛全宫切除的宫颈浸润癌患者,早期手术或延迟手术并不影响总生存率。结论:LEEP术后切除子宫的时间间隔并不影响手术结局,LEEP术后可随时行子宫切除术。但在临床观察中发现,过早手术组织水肿粘连会较为明显,而4～6周后水肿粘连明显减轻,手术难度因此降低。因此,可结合患者意愿,对于过度焦虑的患者,可于LEEP术后4周内手术,而依从性好的患者,可等4周以后再手术。     

宫颈电环切除术对宫颈上皮内瘤变患者妊娠结局的影响

近年来随着液基超薄涂片(TCT)、计算机辅助细胞学检测(CCT)等细胞学新技术和阴道镜在妇产科的广泛应用,宫颈上皮内瘤变(cervica lintraepithelial neoplasia,CIN)检出率明显增加。CIN已成为生育年龄妇女常见的妇科疾病之一[1]。CIN反映宫颈癌发生发展的连续过程,是宫颈癌的高危因素[2]。故宫颈癌防治的重点在于CIN的早期诊断及治疗。宫颈电环切除术(LEEP术)治疗CIN已被全世界推广使用,相对于其他传统手术其具有手术时间短、费用低、出血少、疼痛轻及感染率低等特点[3]。     

术前阴道镜与宫颈环形电切除术后病理检查宫颈上皮内瘤变结果比较

目的:比较宫颈上皮内瘤变(CIN)术前阴道镜检查结果与宫颈环形电切除术(LEEP)后病理检查结果.方法:术前阴道镜下活检,病理诊断的124例CIN患者,其中CIN Ⅰ 39例、CIN Ⅱ 54例、CIN Ⅲ 31例,均行LEEP手术,切除的宫颈组织送病理检查.结果:124例LEEP手术均成功,术中平均出血量5.5±1.6ml.手术平均时间4.7±1.3分钟.术后病理检查结果,同手术前比较,级别相同的56.45%,级别增加的12.82%,级别下降的30.64%.结论:阴道镜下活检取材有盲目性,可能遗漏宫颈癌前病变及宫颈早期浸润癌.宫颈环形电切除术提供了完整的病理标本,组织无炭化,可进一步筛查宫颈癌,两者联合使诊断和治疗宫颈癌前病变更加完善.     

宫颈环形电切术治疗宫颈上皮内瘤变对妊娠结局影响的临床研究

目的:探讨宫颈环形电切术(LEEP)治疗宫颈上皮内瘤变(CIN)对妊娠结局的影响.方法:选取2006年8月至2011年2月因CIN在重庆市妇幼保健院宫颈专科接受LEEP治疗,并有生育计划的患者228例,同时选取同期有生育计划的健康妇女400例作为对照组,随访两组妇女妊娠情况.结果:①实验组228例患者共获得179次妊娠,受孕率78.51％,对照组共获得321次妊娠,受孕率80.25％,两组比较差异无统计学意义(P＞0.05).②实验组92例患者妊娠时限超过20周;对照组225例妊娠时限超过20周,两组孕妇在妊娠时间、早产率、新生儿体重、胎膜早破发生率、宫颈裂伤率等方面差异均无统计学意义(P＞0.05).③实验组剖宫产率为79.12％(72/91),明显高于对照组(54.67％,123/225),差异有统计学意义(P＜0.01).去除以社会因素为指征的剖宫产患者,两组剖宫产率比较差异无统计学意义(P＞0.05).④实验组中宫颈锥切深度与分娩孕周呈负相关(r=-0.438,P＜0.05).结论:LEEP治疗CIN是可行的,正确掌握手术适应证与手术切除深度与范围,对其后的妊娠结局无明显影响.     

宫颈环形电切除术治疗宫颈上皮内瘤变155例临床分析

目的:探讨宫颈环形电切除术(LEEP)治疗宫颈上皮内瘤变(CIN)的临床价值.方法:对经阴道镜下宫颈活检诊断为CIN的155例患者采用LEEP宫颈锥切,观察手术时间、出血量,比较术前宫颈活检与术后病理检查结果,随访疗效和宫颈塑形情况.结果:LEEP治疗CIN平均时间6.8分钟,出血量9.6 ml,阴道镜下宫颈活检的CIN Ⅰ、CIN Ⅱ、CIN Ⅲ与LEEP术后标本的病理诊断CIN Ⅰ、CIN Ⅱ、CINⅢ呈正相关,相关系数r_0=0.785(P<0.01),治愈率为98.7%(149/151),151例中宫颈塑形满意134例(88.7%).结论:LEEP是诊断和治疗CIN安全有效的方法.     

宫颈电环切除术治疗宫颈上皮内瘤变146例随访分析

治疗宫颈上皮内瘤变（CIN）是预防宫颈浸润癌的重要手段，我们对2004年3月至2006年3月在我院接受宫颈电环切除术（LEEP）治疗的146例CIN的患者进行了定期随访，以期评估LEEP治疗CIN的可靠性和CIN术后复发的相关因素。     

宫颈环形电切术术后初次妊娠间隔时间与妊娠结局的关系分析

目的:探讨宫颈环形电切术(LEEP)术后至初次妊娠间隔时间与妊娠结局的关系。方法:选择2012年1月至2015年12月因宫颈上皮内瘤变(CIN)Ⅱ、CINⅢ于我院门诊行LEEP治疗并有妊娠意愿的患者115例,术后定期随访,观察并比较成功妊娠患者一般情况、病理结果、手术至妊娠间隔时间及妊娠结局,分析术后至妊娠间隔时间与妊娠结局的关系。结果:87例LEEP术后成功妊娠,其中早期流产9例(10.3%)、晚期流产9例(10.3%)、早产19例(21.8%)、足月产50例(57.6%)。不同妊娠结局患者一般情况、术前术后病理结果差异无统计学意义(P0.05)。4组间LEEP手术至初次妊娠间隔时间比较,差异有统计学意义(F=3.265,P=0.025)。早期流产患者LEEP术后至初次妊娠间隔时间明显低于足月产患者(P=0.004)。LEEP术后妊娠间隔时间对妊娠结局影响的ROC曲线下面积为0.774(P0.01),对不良妊娠结局具有较好的预测价值,其最佳切割值是13.5。LEEP术后至初次妊娠间隔时间13.5月和≥13.5月患者比较,妊娠结局差异有统计学意义(P=0.023)。LEEP术后至初次妊娠间隔时间≥13.5月较13.5月妊娠后流产发生率低。结论:LEEP术后初次妊娠间隔时间过短早期流产发生率增加,把握好术后妊娠间隔时间可显著降低不良妊娠结局的发生。     

子宫颈锥切术及根治性宫颈切除术术后妊娠问题

近年来国内外资料显示,宫颈上皮内瘤样病变(CIN)和宫颈癌患者有明显年轻化趋势。随着晚婚晚育的妇女越来越多,选择恰当的手术方式保留年轻宫颈宫颈上皮内瘤变(CIN)和宫颈癌患者的生育功能,以及术后妊娠结局是值得重视的问题。1子宫颈锥切术(conization of cervix)1.1适应证与术式宫颈锥切是治疗CIN常用的方法。锥切术的适应证主要为不能定期随访的CIN I,CIN II和CINIII和原位癌(CIS),既可诊断又可治疗,在年轻未育的原位癌患者有重要的治疗地位。微小浸润癌中如ⅠA1也可以考虑锥切术。传统的宫颈锥切术现统称为冷刀锥切(CKC),而…     

干扰素联合宫颈环形电切术治疗宫颈上皮内瘤变临床研究

目的 探讨干扰素联合宫颈环形电切术(LEEP)在治疗宫颈上皮内瘤变(CIN)中的作用.方法 对2003年1月至2005年1月大连市妇幼保健院收治,经细胞学、阴道镜定位活检、宫颈管搔刮术病理检查明确诊断为CINⅡ～Ⅲ级的60例病人,进行前瞻性随机对照研究.并对60例病人行LEEP前应用第2代杂交捕获试验(HC2)检测高危型人乳头瘤病毒(HPV)DNA,其中30例病人术前、术后加用干扰素治疗3个疗程为研究组,同时将单纯行LEEP的30例病人作为对照组.分别于治疗后3、6、9、12个月行液基细胞学检查(TCT)及阴道镜下可疑病灶活检,6、12个月行HC2检测以判断两组的疗效.结果 60例病人随诊中均无CIN残留及复发.治疗前两组各有2例HPV阴性.研究组术后6个月复查TCT 3例异常,HC2检测HPV 27例阴性,阴性率90%;术后12个月治愈率100%.对照组术后6个月复查TCT 16例异常,HC2检测HPV 13例阴性,阴性率43.3%;术后12个月复查TCT 4例异常,HC2检测HPV 19例阴性,治愈率63.3%.术后6个月及12个月研究组与对照组治愈率比较,研究组优于对照组(P＜0.05).结论 干扰素联合LEEP治疗CIN有双重阻断作用,提高了CIN病人一次性治愈率.     

Effectiveness and safety of loop electrosurgical excision procedure in a low-resource setting

Objective

To evaluate the effectiveness and safety of the loop electrosurgical excision procedure (LEEP) to treat cervical intraepithelial neoplasia (CIN) in a low-resource setting.

Methods

Women participating in a cervical screening study in India with histologically confirmed CIN unsuitable for cryotherapy were advised to undergo LEEP. One year after treatment the cervix was visually inspected with acetic acid, followed by colposcopy and biopsy taken from abnormal areas. Cure was defined as no clinical or histologic evidence of CIN. Factors influencing cure rates were evaluated by ^χ2 tests.

Results

Of the 311 women who underwent LEEP, 283 reported for 1-year follow-up and 248 (87.6%) were disease free. Cure rates were 93.0% for CIN 1, 85.5% for CIN 2, and 72.7% for CIN 3. Minor adverse effects were observed in 34 women and complications were seen in 5 women.

Conclusion

LEEP was associated with minimal complications and acceptable cure rates in a low-resource setting, although women with larger lesions had lower cure rates.     

宫颈电圈环切术诊治宫颈上皮内瘤变的临床观察

目的探讨宫颈电圈环切术(LEEP)在诊治宫颈上皮内瘤变(CIN)中的作用。方法选择304例CIN患者作为研究对象,采用LEEP行宫颈锥切术,比较术前宫颈活检与术后病理结果,术后3个月和6个月复查宫颈薄层液基细胞学检测(LCT)、HPV结果。结果与术前活检结果相比术后病理结果降级占3.6%(11/304),相同占91.1%(277/304),升级占5.3%(16/304),浸润癌1例;切缘阳性率为3.9%(12/304)。LCT随访结果,术后3个月正常者99.3%;术后6个月正常者93.8%。HPV随访结果,术后3个月HPV阴性者占91.7%,术后6个月HPV阴性者占92.7%。结论LEEP是诊断及治疗CIN安全且有效的方法。     

Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia

Objective: Previous studies have shown conflicting results on the outcome of pregnancy following loop electrosurgical excision procedure (LEEP). The purpose of this study was to evaluate whether LEEP affects the outcome of pregnancy after 20 weeks gestation. Methods: This is a matched cohort study of all women who had a LEEP for a biopsy-confirmed cervical intraepithelial neoplasia (CIN) in between December 1995 and December 2000 and subsequently delivered (after 20 weeks gestation) at the University Hospital of Northern Norway. Women who had an ectopic pregnancy or an abortion (spontaneous or induced) following LEEP were excluded from analysis. Two controls matched for the date of delivery, age, parity, previous obstetric history and smoking habit were identified for each case using routinely entered data from the birth register. The main outcome measures were the duration of pregnancy and birth weight. Other variables recorded included the grade of cervical dysplasia, size of the electrosurgical loop, age, parity, pregnancy complications, mode of delivery, and perinatal outcome. Results: Of a total of 428 women of reproductive age who had LEEP performed during the study period, 89 had a pregnancy after the procedure. Ten women were excluded (three ectopic pregnancies, two induced abortions and five spontaneous abortions) from the study. Data from 79 women whose pregnancies progressed beyond 20 weeks and 158 matched controls were analysed. The mean age at the time of LEEP was 27 (range 19–36) years. The histological diagnosis was normal in 3 (3.8%), CIN1 in 5 (6.3%), CIN2 in 18 (22.8%), and CIN3 in 53 (67.1%) of the cases. Overall, mean gestation at delivery (38.3 vs. 39.1 weeks), mean birth weight (3,412 vs. 3,563 g), prevalence of preterm birth (11.4% vs. 10.8%) and low birth weight (10.1 vs. 5.1%) were not significantly different among the cases and controls. But when a relatively large loop (25 mm) had been used, the risk of preterm delivery (odds ratio 4.0) and low birth weight (odds ratio 14.0) was significantly higher than in controls. Pregnancy complications occurred more frequently (20 vs. 7%; p=0.006) among the cases than the controls. Conclusion: LEEP in women with CIN did not significantly increase the risk of low birth weight or preterm birth in subsequent pregnancy in comparison to their controls, except when the size of electrosurgical loop was relatively large. However, the prevalence of pregnancy complications was significantly higher after LEEP.     

Persistent and recurrent cervical dysplasia after loop electrosurgical excision procedure

OBJECTIVE: Our objective was to determine whether demographic, colposcopic, and pathologic variables are predictive of recurrent cervical dysplasia. STUDY DESIGN: A retrospective review of patients who underwent loop electrosurgical excision procedure (LEEP) was performed. The medical records of the subjects were reviewed to identify demographic, pathologic, and procedural characteristics that predict recurrent dysplasia. RESULTS: A total of 514 subjects were identified who underwent LEEP between 1996 and 2003. Multivariate analysis revealed that advanced age, immunosuppression, and a positive endocervical margin were associated with recurrent dysplasia. CONCLUSION: Demographic and pathologic data can be used to predict the risk of recurrence of cervical dysplasia after LEEP.     

Effectiveness and safety of loop electrosurgical excision procedure for cervical neoplasia in rural India

Objective

To evaluate the effectiveness and safety of loop electrosurgical excision procedure (LEEP) to treat cervical intraepithelial neoplasia (CIN) in rural India.

Method

Women with CIN colposcopic features unsuitable for cryotherapy were treated with LEEP using a “see-and-treat” approach. Women with unsatisfactory colposcopy had diagnostic LEEP. Cure was defined as no clinical or histologic evidence of CIN at 1-year follow-up. Factors influencing cure rates were evaluated by χ² tests.

Results

Of the 1141 women who underwent LEEP (569 see-and-treat; 572 unsatisfactory colposcopy), 634 had histologically proven CIN. Of those, 489 reported for follow-up and 459 (93.9%) had no evidence of disease. Cure rates were 98.1% for women with CIN 1, 93.6% for CIN 2, and 85.0% for CIN 3. Patients with CIN 2-3 had significantly lower cure rates.

Conclusion

Cure rates for LEEP provided by newly trained doctors in rural India were similar to those reported in the gynecological literature.     

Outcome of loop electrosurgical excision for HIV-positive women in a low-resource outpatient setting

Objective

To assess outcome in HIV-positive women undergoing the loop electrosurgical excision procedure (LEEP).

Method

A prospective study was conducted with 789 outpatients undergoing LEEP at Chiang Mai University Hospital between October 2004 and June 2008.

Results

The 70 HIV-positive women (8.9%) were younger (P < 0.001) and had a lower parity (P < 0.001) than the remaining women. The proportion of women undergoing LEEP for persistent low-grade lesions was higher (8.6% vs 1.9%) and the prevalence of margin involvement was higher (60.0% vs 49.4%) among the HIV-positive women. After adjusting for age, parity, menopausal status, size of excised lesion, and histopathologic result, HIV infection was not significantly associated with LEEP complications (adjusted odds ratio, 0.41; 95% confidence interval, 0.15-1.15).

Conclusion

The higher risk of resection margin involvement in HIV-infected women was not associated with LEEP complications.     

妊娠期行宫颈环形电切除术的安全性及对妊娠结局的影响

随着宫颈病变的年轻化以及宫颈环形电切除术的广泛开展,妊娠期行宫颈环形电切除术的安全性及对妊娠结局的影响成为医患双方共同关注的焦点。妊娠期宫颈病变有较小的恶化趋势,妊娠期可予随访,定期行细胞学及阴道镜检查,于产后6周复查,根据病理结果按宫颈病变妇科治疗原则处理。宫颈癌前病变及原位癌的稳定状态与分娩方式无关,分娩方式的选择取决于产科指征,无特殊指征的患者仍提倡阴道分娩。宫颈环形电切除术对妊娠结局的影响尚有争议,须进一步大样本研究证实。