子宫颈上皮内瘤变患者行宫颈环切术对妊娠结局的影响

目的探讨对宫颈上皮内瘤变患者行宫颈环切术对妊娠结局的影响。方法回顾性分析2001年5月～2010年4月对宫颈上皮内瘤变患者行宫颈环切术27例患者的妊娠结局。结果占同期宫颈环切术宫颈环切术手术的13.3%(27/203),患者年龄为23～40岁,中位年龄为30.3岁。27例中,10例因计划生育行人工流产术、1例异位妊娠、2例6～8周自然流产。14例足月分娩,其中阴道分娩9例,剖宫产5例。所有分娩孕妇的分娩孕周均大于38周,新生儿体重2905～4000g。新生儿1minApgar评分:9分2例;10分12例。无新生儿窒息。结论宫颈环切术是治疗宫颈上皮内瘤变的安全有效的方法。只要掌握手术指征和手术切除范围,对其后的妊娠生育是安全的。     

LEEP刀宫颈环形电切术治疗宫颈上皮内瘤变102例临床观察

目的 分析LEEP刀宫颈环形电切术治疗宫颈上皮内瘤变疗效.方法 在200例宫颈上皮内瘤变患者中,102例患者采用LEEP刀宫颈环形电切术进行治疗,作为治疗组;98例患者采用传统冷刀宫颈锥切术进行治疗,作为对照组,分别比较了两种手术方法的手术时间、手术中出血量、切口愈合时间及手术前后病理变化.结果 对照组和治疗组疗效相当,治疗组手术时间以及切口愈合时间出血量少,具有显著统计学意义(P＜0.05).结论 该法术中出血量较少,优于冷刀宫颈锥切术,值得临床推广使用.     

宫颈环形电切术治疗慢性宫颈炎76例疗效观察

目的探讨宫颈环形电切术（LEEP刀）治疗慢性宫颈炎的疗效观察。方法回顾性分析2012年2月～12月76例慢性宫颈炎患者采用宫颈环形电切术（LEEP刀）治疗的效果。结果 LEEP刀治疗慢性宫颈炎手术时间短,术中出血量少,术前宫颈刮片细胞学检查或 TCT检查结果与 LEEP刀术后病理结果诊断一致率为98.6%（75/76）,宫颈塑形满意。结论 LEEP刀是治疗慢性宫颈炎疗效好、并发症少的理想治疗方法。     

探讨宫颈环形电切术在宫颈癌前病变治疗中的临床效果

目的：探讨宫颈环形电切术在宫颈癌前病变治疗中的临床效果。方法选取60例宫颈癌前病变患者作为研究对象,按随机数字法将其分为对照组和观察组,每组各30例。对照组患者实施保守治疗,观察组患者采用宫颈环形电切术进行治疗。观察两组患者在CIN、宫颈息肉、宫颈糜烂等方面的疗效。结果观察组患者在CIN、宫颈息肉、宫颈糜烂等方面疗效明显优于对照组,治疗有效率高于对照组。结论说明宫颈环形电切术对于控制宫颈癌前病变具有积极作用,可以有效预防宫颈癌的发生,值得在临床上被大力推广使用。     

包皮环切术商榷

1包茎手术要解决什么问题这个问题早已明确,包皮环切手术最早做为伊斯兰国家的一种割礼——这个宗教仪式,在1550年就有记载。包皮环切术适用于两种疾病,即包茎和包皮过长。上述两种疾病均可致包皮垢积聚,导致感染,发生包皮龟头炎、包皮结石,长期慢性刺激可致阴茎癌,以包茎尤甚,     

应用电环切活检术诊断宫颈上皮内瘤变

近年来,我院开展阴道镜下电环切除术（LEEP）诊治宫颈上皮肉瘤变（CIN）,现报道如下。1材料和方法24例标本取自1995年11月～1998年11月在我院阴道镜专科门诊的病例,原经细胞学检查或外院诊断为CIN,年龄范围为22～46岁。配备直径为0．1～0．3mm的不锈钢丝环状电极,在高功率、低电压下工作。以可疑病灶及相邻3～5mm正常组织为切除范围,在阴道镜下定位,电切深度1．5～2cm。切除组织标记定位,以10％福尔马林固定后多部位取材,常规石蜡切片,HE染色,光镜下观察。2结果2．1阴道锦观察诊断为CIN1级11例,2级3例,3级4例,慢性宫颈…     

商环包皮环切术和传统包皮环切术的疗效和手术并发症

目的：对比商环包皮环切术和传统包皮环切术治疗包茎及包皮过长的临床效果及并发症差异。方法：根据患者入院顺序将376例包茎及包皮患者分为商环组与传统组各188例,商环组采用商环包皮环切术、传统组采用包皮背部切开激光环切术治疗,比较两组患者的围手术期指标、术后并发症。结果：商环组的手术时间(4.3±1.2) min、术中出血量(2.0±0.6) mL、术中疼痛评分(1.1±0.7)分均显著的低于传统组、创口愈合时间(18.4±4.2) d显著的高于传统组且差异均具有统计学意义(P<0.05)。商环组术后1、12、24 h的疼痛评分均显著的低于传统组且差异均具有统计学意义(P<0.05)。商环组术后出血率、包皮水肿率均显著的低于传统组且差异均具有统计学意义(P<0.05),商环组的术后外观满意度(86.84%)显著的高于传统组(65.79%)且差异具有统计学意义(P<0.05)。术后商环组的IIEF-5、TSS评分均显著的高于传统组(P<0.05)。结论：商环包皮环切术较传统包皮环切术治疗包茎及包皮过长具有手术时间短、出血量少、术后并发症率低、恢复效果好的优势。     

宫颈锥切术后行子宫全切术的间隔时间对 手术效果的影响分析

目的 探讨宫颈锥切术后再行子宫全切术的手术间隔时间对手术并发症的影响。方法 回顾性分析2012年1月~2018年10月银川市妇幼保健院宫颈锥切术后行子宫全切术76例患者临床资料,按照手术间隔时间不同分为三组,宫颈锥切术后72 h内行子宫全切术的22例患者设为A组;宫颈锥切术后72 h~4周行子宫全切术的患者25例设为B组;宫颈锥切术后4周以上行子宫全切术的29例患者设为C组,比较三组之间术中出血、手术时间、术后体温、手术并发症。结果 三组之间术中出血、手术时间比较,差异无统计学意义（P＞0.05）,而三组之间术后体温≥38℃的天数比较,差异有统计学意义（P＜0.05）,且B组术后体温≥38℃的天数多于A组与C组,差异有统计学意义（P＜0.05）。B组并发症发生率为44.00%,分别高于A组的13.64%和C组的13.79%,差异有统计学意义（P＜0.05）。结论 宫颈锥切术后72 h~4周行子宫全切术,术后并发症发生率高,术后感染率高,应避免在此时间段手术。     

改良袖套式包皮环切术治疗包皮过长28例报告

目的探讨改良袖套式包皮环切术治疗包皮过长患者的疗效。方法采用改良袖套式包皮环切术治疗包皮过长患者28例。术中先标志包皮切除长度,在直视下于包皮内、外板作两个互相平行的环形切口,将两切口间包皮条用小圆头刀锐性剥离,保留完整肉膜及皮下浅层血管,并保留完整的包皮系带。结果28例术中出血极少,切口整齐,术后伤口无水肿,无继发性出血及感染,均一期愈合,切口瘢痕少,阴茎外形美观。结论改良袖套式包皮环切术对包皮过长患者治疗效果满意。     

新式包皮环切术与传统术式的临床疗效比较

包茎和包皮过长是泌尿外科门诊常见的疾病,传统的临床治疗都是以传统包皮环切术为主,我院2010年11月至2011年11月采用一次性包皮环切吻合器行包皮环切术102例,取得了较好疗效,现报告如下。 1资料与方法 1．1临床资料 本组患者201例,年龄6-60岁,平均26．8岁,其中102例为新术式组,采用一次性包皮环切吻合器行包皮环切,传统术式组99例如行传统包皮环切术。两组患者在年龄组成、包茎和包皮过长所占比例、手术时机选择、参与手术人员、术后处理等情况具有可比性。     

子宫颈电环切除术治疗宫颈疾病的临床分析

目的评价一次LEEP同时达到治疗和诊断宫颈疾病的临床价值。方法对经妇科细胞学、阴道镜及活检初步诊断为各种宫颈病变收住院的250例患者,采用LEEP治疗,切除全部宫颈移行区。切除组织全部送病理。观察手术时间、出血量、病人反应及术后修复情况。结果LEEP治疗成功率为98%(245/250)。平均手术时间为4.2分钟,出血量5.7ml。无继发性出血和感染发生。结论LEEP治疗宫颈病变操作简单、安全、成功率高,尤其适用于CIN。     

偏远地区高频电波刀诊疗宫颈病变517例临床分析

目的探讨高频电波刀（loop electrosurgical excision procedure,LEEP）偏远地区宫颈疾病诊治中的疗效、价值及近远期并发症。方法分析我院2006年10月至2009年10月517例经LEEP治疗或行宫颈锥切手术切除病变组织的不同类型宫颈疾病的患者,对手术出血量、手术时间及术后疗效进行评价。结果517例患者中,LEEP治愈率为97．29％。术后病理诊断与术前完全符合者占75．05％,术后病理级别下降占9．86％,术后病理级别上升占15．09％;LEEP术的平均出血量为71mL,平均手术时间为6．9min。结论LEEP术时间短、出血少、术后并发症少、疗效确切,适合在偏远地区推广使用。     

Significance of disease extent in high-grade cervical intraepithelial neoplasia excised with negative margins by loop electrosurgical excision procedure

Approximately 15% of patients with high-grade cervical intraepithelial neoplasia (CIN 2-3), treated by the loop electrosurgical excision procedure (LEEP) will experience a persistence or recurrence of their disease. The full spectrum of pathologic factors that may be predictive of an increased probability of this event remains to be elucidated. In this work, we evaluate the significance of disease extent in a group of patients with CIN 2 to 3 that was completely excised by LEEP (ie, endocervical and ectocervical margins were negative). From 102 patients whose LEEP specimens had negative margins during a 5-year period, at least 1 cytologic follow-up was available in 87 patients (median follow-up, 23 months). For patients with multiple follow-up cytologic samples, the most severe cytologic abnormality was used for the purpose of this analysis (1 sample per patient). Extent of disease was determined semiquantitatively by calculating for every case the proportion of processed slides on which any CIN 2 to 3 could be identified. The 87 cases were classified into 3 groups (<33%, 33%-66%, >66%) for ease of statistical comparison (Fisher exact test). There were 10 recurrences of high-grade squamous intraepithelial lesion (HGSIL) among the 87 patients with follow-up. There were no statistically significant differences between the aforementioned 3 groups regarding the follow-up diagnostic frequencies of HGSIL (10% in the <33% group, 40% in the 33%-66% group, and 50% in the >66% group) and "negative for intraepithelial lesion or malignancy" (32.25% in the <33% group, 25.8% in the 33%-66% group, and 35.48% in the >66% group). If confirmed, our findings suggest that in an LEEP specimen with CIN 2 to 3 that was excised with negative margins, the extent of disease lacks prognostic significance and need not be reported.     

Completeness of excision and follow up cytology in patients treated with loop excision biopsy

AIMS: To assess the relation between the grade and the status of follow up cytology, the completeness of loop excision biopsies with cervical intraepithelial neoplasia (CIN), and the findings at follow up cytology, as well as the differences between complete and incomplete exclusion, using the odds ratio. Treatment failure was assessed. METHODS: 1600 women with CIN (290 CIN1, 304 CIN2, 1006 CIN3) were followed for a minimum of six months and a maximum of 10 years. A database was created and comparisons performed. The mean age of the patients was 37 years. RESULTS: Excision was complete in over 84% of loops. Residual disease and recurrence of high grade dyskaryosis was more common in women with CIN 3 than CIN 2 or 1. No high grade dyskaryosis was seen in the fifth follow up smear in patients with CIN 1 and CIN 2. Residual, recurrent, and persistent disease was most common in patients with incompletely excised CIN at ectocervical and endocervical margins and deep margins of resection than in patients with completely excised CIN. The odds ratios were significantly higher in the women who had incomplete excision of CIN at ectocervical, endocervical, both ecto- and endocervical, and deep margins of resection compared with those with apparent complete excision of CIN lesions. One patient developed invasive squamous cell carcinoma 44 months after loop excision which showed CIN 3 invading endocervical crypts and extending to both ectocervical and endocervical margins of resection. CONCLUSIONS: At long term follow up, patients with CIN who have residual disease are at increased risk of persistent disease and should therefore be followed up regularly with cytology and colposcopy. The findings support national policy of returning women with treated CIN of any grade to normal recall after five years except for cases of CIN3 where excision was incomplete or equivocal. In these cases follow up with annual smear for 10 years is recommended.     

Negative loop electrosurgical excision procedure (LEEP) following cervical biopsy diagnosis of high grade squamous intraepithelial lesion

Context: Loop Electrosurgical Excision Procedure (LEEP) is commonly performed after cervical biopsy diagnosis of high grade squamous intraepithelial lesion (HSIL/CIN2 or CIN 3). Histological and immunohistochemical assessments are made to differentiate reactive and metaplastic changes from dysplastic changes. A Human Papillomavirus (HPV) test is used for prognostic assessment after conization. Objective: We retrospectively reviewed cases where the cervical biopsy showed HSIL but the LEEP specimen was negative for high grade dysplasia. Our aim was to determine the cause of miscorrelation. Data: IRB approval was obtained and a search was made of all LEEP specimens received during 2018. We reviewed 25 of 137 LEEP specimens that did not correlate with the diagnosis of HSIL rendered on the cervical biopsy. These were from women between 25 to 54 years. All cases had positive high-risk HPV with 80% being non16/18 subtype. On review, 8/25 had HSIL with the remainder of cases falling short of HSIL diagnosis. Follow up cytology with HPV test after the LEEP procedure was negative in all but one case of LSIL with persistent non-16/18 HPV. Conclusion: The study highlights the diagnostic difficulties of distinguishing HSIL from immature squamous metaplasia. The practical implication is that in cases with non-16/18 high risk HPV which have thin epithelium and fall short of definite morphologic criteria of HSIL, presence of immature squamous metaplasia should be carefully evaluated. The specific role of CK7 and CK17 which highlight squamocolumnar junctional cells and metaplastic cells, respectively, needs to be explored in these cases.     

阴道镜下多点活检联合LEEP术诊治宫颈上皮内瘤变的临床效果

目的探讨阴道镜下多点活检联合LEEP术在宫颈上皮内瘤样变(CIN)诊治中的应用价值。方法 60例经阴道镜下多点活检病理诊断为CINⅡ～Ⅲ级患者,应用LEEP术诊治,比较阴道镜下多点活检病理结果与LEEP术后病理结果,观察治愈率和术后并发症发生情况。结果经阴道镜下多点活检病理证实的60例CINⅡ～Ⅲ级患者,LEEP术后经病理诊断相符42例,诊断符合率为70.0%。29例CINⅡ级经LEEP术后病理诊断符合率为79.3%(29/60),31例CINⅢ级经LEEP术后病理诊断符合率为61.3%(31/60);LEEP术后治愈率为93.3%,复发率为1.7%,术后并发症发生率为3.3%。结论阴道镜下多点活检联合LEEP术诊治CINⅡ～Ⅲ级可以提高诊断率,降低误诊率;且LEEP术治疗CINⅡ～Ⅲ级治愈率高,复发率和术后并发症低。     

LEEP术治疗宫颈上皮内瘤变的疗效分析

目的探讨高频电波刀环形电切除术（LEEP）治疗宫颈上皮内瘤变（CIN）的临床疗效。方法回顾性分析127例患者的临床资料,观察手术前后病理结果、手术时间、出血量和并发症等情况。每3-6个月及3个月后,每TCT或阴道镜复查的结果。结果手术平均时间3.5 min,术中平均出血10 mL;手术成功率91.3%,并发症发生率8.6%;术前与术后病理诊断结果一致占81.1%,所有手术标本切缘均阴性。结论 LEEP手术时间短,术中出血少,是治疗宫颈上皮内瘤变的首选方法。     

Limiting factors for cytopathological diagnosis of high-grade squamous intraepithelial lesions: a cytohistological correlation between findings in cervical smears and loop electrical excision procedure.

The present study sought possible factors leading to the cytological diagnosis of atypical squamous cells of uncertain significance (ASCUS) in cases of high-grade squamous intraepithelial lesions (HSIL). Based on retrospective histopathological analysis of loop electrical excision procedure (LEEP) products that diagnosed HSIL, two study groups were randomly selected. The first was consisted of cases with two consecutive Papanicolaou (Pap) smears with the diagnosis of ASCUS. The second (control) group was represented by cases diagnosed as HSIL by cytology. From the Pap smears diagnosed as ASCUS, the sampling limitations was different from control group (P < 0.05). The median size of the largest lesion in each case with ASCUS was 2.66 mm (+/- 1.71 mm). In the control group, the median size of the largest lesion was 5.15 mm (+/-2.58 mm) (P < 0.05). The size of the lesion and sample limitations led patients with cervical intraepithelial neoplasms to be diagnosed as ASCUS for two consecutive times, after a 6-mo period.