宫颈环形电切术治疗宫颈上皮内瘤变56例临床分析

[目的]探讨宫颈环形电切术（LEEP）治疗宫颈上皮内瘤变（CIN）的疗效。[方法]总结分析LEEP治疗CIN56例的临床资料。[结果]LEEP治愈CIN51例,治愈率为91.07%,其中CIN1级治愈率达100%。56例CIN患者术中出血量2～15ml,平均4.6ml。术后并发症主要为阴道不规则出血。[结论]LEEP治疗CIN疗效确切,具有操作简单、诊断准确、安全有效、出血量少等优点。     

系统回顾:宫颈环形电切术与冷刀锥切术治疗宫颈上皮内瘤变及宫颈原位腺癌的对

由于宫颈癌筛查方案的普及,越来越多的宫颈癌前病变及早期宫颈癌得以及时发现及治疗。宫颈环形电切术（loop electrosurgical excisional procedure,LEEP）及冷刀锥切术（cold knife conization,CKC）作为保守手术方案的代表被广泛使用。本文对LEEP与CKC治疗宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）及宫颈原位腺癌（cervical adenocarcinoma in situ,ACIS）的安全性及有效性进行多方面对比,得出以下结果:对于CIN,LEEP虽然较CKC有着更高的术后复发率,但是在手术时间、术中及术后出血量、住院时间、术后感染率、宫颈管狭窄以及阴道镜检查不满意比例等方面有着明显的优势;对于ACIS,LEEP的切缘阳性率显著高于CKC,二者残留病率及复发率无明显差异;考虑到长期并发症,LEEP较CKC有着早产风险低的优势。总之,根据参考文献,LEEP与CKC均为治疗CIN以及ACIS的安全且有效的手段。对于年轻有生育要求患者,LEEP可能是更好的选择,但需术后严密随访。     

宫颈环形电切术与冷刀锥切术治疗CINⅡ、Ⅲ级疗效分析

目的 评价宫颈环行电切术(LEEP)和宫颈冷刀锥切术(CKC)治疗宫颈上皮内瘤变Ⅱ、Ⅲ级(CINⅡ、Ⅲ)的临床疗效.方法 回顾性分析我院2014年1月至2015年6月收治的124例经阴道镜活检病理确诊为CINⅡ、Ⅲ级患者的临床资料,比较LEEP术(LEEP组,50例)和CKC术(CKC组,74例)治疗CINⅡ、Ⅲ级的临床疗效及术后不良反应发生率.结果 LEEP组术中出血量、手术时间均少于CKC组,差异有统计学意义(P＜0.05);LEEP组术后并发症发生率明显低于CKC组,差异有统计学意义(P ＜0.05);LEEP组术后锥切组织切缘阳性率大于CKC组,差异有统计学意义(P＜0.05);2组术后病理累腺率比较差异无统计学意义(P＞0.05);锥切组织大小比较,CKC组锥切面积、锥高均大于LEEP组,差异有统计学意义(P＜0.05).术后疗效比较,LEEP组与CKC组术后病灶残留率及治愈率比较差异均无统计学意义(P均＞0.05);CKC组复发率明显小于LEEP组,差异有统计学意义(P＜0.05);LEEP组术后高危型HPV感染率高于CKC组,差异有统计学意义(P＜0.05).结论 LEEP出血少、手术时间短以及术后并发症少的优势较易被患者接受,但CKC在锥切组织大小可控性、降低切缘阳性率、减少术后复发及高危型HPV感染率等方面优于LEEP.     

宫颈冷刀锥切术在宫颈上皮内瘤变诊治中的评价

背景与目的：宫颈冷刀锥切术(cold knife conization,CKC)是一种经典的诊治方法,本研究取62例宫颈锥切标本,分析宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)的组织学特点,探讨CKC在CIN诊断治疗中的临床意义。方法：对比分析62例行CKC的CIN患者病理标本与术前多点活检的病理所见。结果：CKC与术前多点活检结果完全符合者有44例(71％);有差异者18例(29％),其中4例术前多点活检为CIN2和CIN3,而锥切为CIN3和微小早期浸润癌。62例均为鳞状上皮病变,其中34例为CIN3或以上,病变主要位于移行区,常累及宫颈管,30例(88．2％)同时累及≥2个象限,37例(59．7％)有HPV感染,31例(50％)鳞状上皮化生,8例伴不同程度的非典型增生。切缘病变残留率分别是3．2％(≥CIN2)和8．1％(CIN1),低于文献报道的宫颈环形电切(loop electrosurgieal excision,procedure)的残留率。56例患者随访4个月--14年。均无复发,3例术后妊娠分娩。结论：宫颈锥切在宫颈CIN的诊治中仍有其优势。     

宫颈冷刀锥切术与宫颈电环锥切术治疗宫颈上皮内瘤变的远期随访观察

目的 探讨宫颈冷刀锥切术(CKC)与宫颈电环锥切术(LEEP)治疗宫颈上皮内瘤样病变(CIN)的疗效.方法 180例经阴道镜下多点病理活检确诊为CINⅢ级的患者根据手术方式分为2组,90例患者行CKC治疗作为CKC组,其余90例行LLEP治疗作为LEEP组,记录2组手术情况,随访2 a,记录2组复发率、切缘阳性率、妊娠率.结果 LEEP组手术时间、切口愈合时间及住院时间均较对照组短,术中出血量较对照组少,差异均有统计学意义(P均<0.05);2组术后痊愈率和并发症发生率比较差异均无统计学意义(P均>0.05);2组患者术后2 a切缘阳性率、复发率及妊娠率比较差异均无统计学意义(P均>0.05).结论 CKC与LEEP治疗CIN的手术效果及远期疗效相近,但与CKC相比,LEEP手术时间短,术后恢复快.     

宫颈环形电切术与根治性宫颈切除术对子宫上皮内瘤变的疗效观察

目的：观察宫颈环形电切术与根治性宫颈切除术治疗子宫上皮内瘤变的疗效。方法选择子宫上皮内瘤变（ CIN）患者160例,按照随机数字表法分为观察组和对照组。对照组采用宫颈环形电切术,观察组采用根治性宫颈切除术,观察两组手术效果。结果 CINⅡ患者观察组治愈率和复发率分别为100％和0,对照组治愈率和复发率分别为94．0％和4．0％;CINⅢ患者观察组治愈率和复发率分别为96．4％和0,对照组治愈率和复发率分别为90．0％和3．3％,观察组略优于对照组,但组间比较,差异不显著,P＞0．05。观察组手术时间、术中出血量均明显优于对照组,观察组切除多个淋巴结,对照组未切除淋巴结,组间比较,均差异有显著性,P＜0．05或P＜0．01。对照组术后镇痛药使用例数明显多于观察组,组间比较,差异有显著性,P＜0．05;观察组术后并发症发生率为11．3％,对照组术后并发症发生率为15．0％,组间比较,差异不显著,P＞0．05。结论宫颈环形电切术和根治性宫颈切除术治疗CIN均有一定疗效,但根治性宫颈切除术在术中出血量、手术时间、切除淋巴结方面更有优势。     

宫颈锥切术治疗宫颈上皮内瘤变的疗效及并发症

目的探讨宫颈上皮内瘤变采用宫颈锥切术治疗的临床效果及对术后并发症的影响。方法选取2016年5月至2017年5月间龙泉驿区第一人民医院收治的84例宫颈上皮内瘤变患者,采用随机数字表法分为研究组和对照组,每组42例。研究组患者采用宫颈锥切术治疗,对照组患者采用宫颈环形电切术治疗,比较两组患者手术情况及术后并发症发生情况。结果研究组患者治愈率为73. 8%,复发率为2. 4%,对照组患者治愈率为50. 0%,复发率为14. 3%,两组比较,差异均有统计学意义(均P <0. 05)。研究组患者术后并发症发生率为7. 1%,低于对照组的26. 2%,差异有统计学意义(P <0. 05)。研究组患者手术时间、出血量、住院时间及住院费用均高于对照组,差异均有统计学意义(均P <0. 05)。结论宫颈锥切术治疗宫颈上皮内瘤变患者,术后并发症发生率较低,有效降低术后复发率,手术效果更彻底,临床应推广应用。     

宫颈环形电切术治疗宫颈上皮内瘤变的临床疗效以及高危型人乳头瘤病毒检测在术后随访中的应用价值

目的探讨临床应用宫颈环形电切术(LEEP)治疗宫颈上皮内瘤变的临床效果以及高危型人乳头瘤病毒(HPV)检测对预后效果的评估价值。方法 2012年2月至2014年2月间收治的宫颈上皮内瘤变患者108例随机分为对照组和观察组,每组54例。对照组采用宫颈冷刀锥切术,观察组采用宫颈环形电切术,比较两组患者的临床治疗效果。同时,分别于术前与术后3个月开展高危型HPV检验,观察其对预后效果的评判价值。结果观察组患者的手术时间为(7.5±1.5)min,出血量为(8.2±3.1)ml,术后愈合时间为(28.0±3.2)d,均明显好于对照组,差异有统计学意义(P<0.05)。108例患者术后HPV阳性者的复发率与持续存在率均明显高于阴性者,差异有统计学意义(P<0.05)。结论宫颈环形电切术治疗宫颈上皮内瘤变具有较好的手术治疗效果,术后采用高危型HPV检测具有确切的预测效果。     

318例宫颈上皮内瘤变的临床分析

目的探讨宫颈上皮内瘤变(CIN)的临床特点及诊治动向。方法对1999年1月~2003年12月住院治疗318例CIN的临床资料进行回顾分析。结果近5年收治的CIN病例按年平均数计算(63.6例)为前15年(10例)的6.4倍。平均年龄提前6岁,宫颈原位癌提前8.3岁。阴道镜下多点活检与锥切和子宫切除术后病理对照,诊断完全一致208例(65.4%),降级47例(14.8%),阴性11例(3.5%),升级52例(16.4%),包括CINⅠ、Ⅱ级升至CINⅢ级30例(32.6%);CINⅢ级升至早期浸润癌20例(8.8%)及浸润癌2例(0.9%)。CINⅢ级中宫颈原位癌治疗方式在3个阶段(1958~1983,1984~1998,1999~2003年)有明显变化,冷刀锥切的比例从3.0%增到42.2%,子宫切除从77.3%减至52.2%,子宫次广泛切除从27.6%降至4.4%,腔内放疗从28.5%减到零。结论近年CIN病例有上升现象,且有年轻化趋势。细胞学 阴道镜下多点活检 颈管刮术 病理不失为CIN的联合早诊方法。在CIN治疗中宫颈冷刀锥切具有重要价值。     

宫颈环形电切术治疗宫颈上皮内瘤变患者的妊娠结局及其相关影响因素分析

目的探讨宫颈环形电切术治疗宫颈上皮内瘤变的妊娠结局及其相关影响因素。方法选择行LEEP治疗的CIN妊娠者78例作为观察组,随机选择同期分娩的78例健康孕妇作为对照组。记录比较2组妊娠者的分娩方式,妊娠结局,妊娠时间,产程时间,新生儿情况等;分析妊娠结局的相关影响因素。结果观察组剖宫产率74.36%,显著高于对照组的44.87%(χ~2=17.285,P=0.000);早产率16.67%,显著高于对照组的6.41%(χ~2=4.019,P=0.045);产程时间(10.78±1.53)h,长于对照组的(9.94±1.46)h(t=3.508,P=0.001)。与妊娠结局相关的因素有:切除组织体积、剩余宫颈管长度(P<0.05)。结论 LEEP术后妊娠者剖宫产率、早产率及产程时间增加,切除组织体积及剩余宫颈管长度与妊娠结局密切相关。     

子宫颈环型电切术治疗子宫颈上皮内

摘 要：［目的］ 分析子宫颈环型电切术（LEEP）治疗子宫颈上皮内瘤变（CIN）的疗效及其影响因素、术后随访时机,为LEEP规范化治疗CIN提供科学依据。［方法］ 选择2009年6月至2010年12月在深圳市妇幼保健院因CIN行LEEP治疗病例1535例作为研究对象,并在术后随访2年,观察LEEP治疗效果。［结果］ 1535例患者中排除确诊为浸润癌的13例患者,随访2年时间共1297例,随访率为85.2%（1297/1522）,其中持续存在或复发35例（含浸润癌1例）,病变持续存在或复发率2.7%;治愈1262例,治愈率97.3%。术后切缘阳性组病变持续存在或复发率明显高于阴性组（P＜0.01）。术前HPV16/18亚型感染患者LEEP治疗失败风险是其他亚型感染患者的3.383倍。术后第6个月HR-HPV载量≥1.0×105 copies/ml的患者病变持续存在或复发率明显高于< 1.0×105 copies/ml者（OR=23.851,P＜0.01）。术后第6个月HR-HPV阳性率和细胞学检查阳性率明显下降,较术后第3个月明显降低 (P<0.05),与术后6个月后的HR-HPV阳性率和细胞学检查阳性率无统计学差异(P>0.05)。［结论］ LEEP治疗CIN的治愈率较高,并发症的发生率相对较低;切缘阳性、HPV16/18亚型感染、术后第6个月HR-HPV载量≥1.0×105 copies/ml是本组研究对象LEEP治疗后子宫颈上皮内瘤变持续存在或复发的影响因素;LEEP治疗后6个月是评价疗效的起始时间。     

Long-term Outcomes of a Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia in a High Incidence Country

Aim: To evaluate the operative, oncologic and obstetric outcomes of the loop electrosurgical excision procedure(LEEP) in cases with cervical neoplasia. Materials and Methods: A retrospective cohort study was conducted onpatients who were suspected of cervical neoplasia and therefore undergoing LEEP at Siriraj Hospital, MahidolUniversity, Thailand, during 1995-2000. Outcome measures included operative complications in 407 LEEPpatients and long-term outcomes in the 248 patients with cervical intraepithelial neoplasia (CIN) who weretreated with only LEEP. Results: There were 407 patients undergoing LEEP; their mean age was 39.7±10.5years. The histopathology of LEEP specimens revealed that 89 patients (21.9%) had lesions ≤CIN I, 295 patients(72.5%) had CIN II or III, and 23 patients (5.6%) had invasive lesions. Operative complications were found in15 patients and included bleeding (n=9), and infection (n=7). After diagnostic LEEP, 133 patients underwenthysterectomy as the definite treatment for cervical neoplasia. Of 248 CIN patients who had LEEP only, seven(2.8%) had suffered recurrence after a median of 16 (range 6-93) months; one had CIN I, one had CIN II, andfive had CIN III. All of these recurrent patients achieved remission on surgical treatment with re-LEEP (n=6) orsimple hysterectomy (n=1). A significant factor affecting recurrent disease was the LEEP margin involved withthe lesion (p=0.05). Kaplan-Meier analysis showed 5-year and 10-year disease-free survival (DFS) estimates of99.9%. Twelve patients became pregnant a total of 14 times, resulting in 12 term deliveries and two miscarriages- one of which was due to an incompetent cervix. Conclusions: LEEP for patients with cervical neoplasia deliversfavorable surgical, oncologic and obstetric outcomes.     

海岛妇女LEEP治疗高级别宫颈上皮内瘤变168例临床分析

目的：探讨宫颈上皮内瘤样病变（CIN）Ⅱ～Ⅲ宫颈环形电刀切除术（LEEP）治疗的有效性。方法：回顾分析浙江省舟山市妇幼保健院2002年6月至2007年9月因CINⅡ～Ⅲ行LEEP手术的168例患者临床资料，对手术前后病理、术后患者的治愈率、病变持续存在及复发等情况进行分析总结。结果：手术前后病理诊断符合率64.3%（108/168），升级占12.5%（21/168），降级占23.2%（39/168）。剔除LEEP术后切缘阳性或宫颈癌再次手术者19例，接受6～69个月随访者149例，总治愈率96.0%（143/149），病变持续存在率4.0%（6/149），复发率12.1%（18/149）。LEEP术后CINⅡ41例，6个月治愈率95.1%（39/41），病变持续存在率4.9%（2/41），1年复发率为7.3%（3/41），2年复发率为7.3%（3/41）；CINⅢ81例，6个月治愈率95.1%（77/81），病变持续存在率4.9%（4/81），1年复发率为6.2%（5/81），2年复发率为7.4%（6/81），3、4、5年均无复发。CINⅡ、CINⅢ在治愈率、病变持续存在率、复发率方面比较差异无显著性（P=0.963）。LEEP术后病理切缘阳性者、阴性者复发率分别为33.3%（3/9）、10.7%（15/140），两者比较差异无显著意义（P=0.065）；病变持续存在率分别为22.2%（2/9）、2.9%（4/140），两者比较差异有显著意义（P=0.040）。病变持续存在与术后病理切缘是否受累有关，与病变级别无关。结论：对于阴道镜下点状活检诊断为CINⅡ～Ⅲ适宜行LEEP，不仅达到治疗目的，而且能进一步明确宫颈病变程度，但术后应密切随访，尤其术后前2年。     

Recurrent Rates with Cervical Intraepithelial Neoplasia having a Negative Surgical Margin after the Loop Electrosurgical Excision Procedure in Thailand

LEEP conization has become the treatment of choice in patients presenting with high grade intraepitheliallesions (HSILs) especially in cases with negative surgical margins. However, surveillance after such treatmentis necessary due to the potential for recurrence. To evaluate the recurrent rate in patients with negative surgicalmargins after HSIL treatment with LEEP, the medical records of such patients treated between January 2000and June 2007 were reviewed. All of them subsequently underwent Pap smears every 4-6 months to detect therecurrence of cervical intraepithelial neoplasia. There were 272 patients in the study period. Of these, 9 (3.3%)developed abnormal Pap smears with a median follow up of 12 months. The abnormal smears featured: atypicalsquamous cells of undetermined significance in 5 cases; atypical squamous cells where high grade squamouscell intraepithelial lesion cannot be excluded in 2 cases; and low grade squamous intraepithelial lesions in the 2remaining cases. Further investigation with colposcopic directed biopsies were conducted in all who exhibitedan abnormal Pap smear and only 3 of them (1.1%) showed cervical dysplasia at biopsy. In conclusion, thepatients with HSIL who were treated with LEEP and have negative surgical margins have a very low recurrencerate.     

芬太尼复合异丙酚麻醉在宫颈环状电切术中的应用

[目的]观察芬太尼复合异丙酚麻醉用于宫颈环状电切术(LEEP术)的可行性和安全性。[方法]选择60例需要行LEEP术的女性患者,随机分成F P组和P组,每组30例。麻醉诱导:F P组是先芬太尼1.0μg/kg,2min后加注异丙酚;P组是单用异丙酚。两组麻醉维持均是采用微泵注射异丙酚3.0mg/(kg·h)～5.0mg/(kg·h)。记录血压、心率、呼吸频率、氧饱和度、意识消失及睁眼时间、异丙酚用量、OAA/S评分。[结果]异丙酚用量和意识消失时间P组大于F P组(P<0.05);P组患者麻醉诱导后1min、3min血压较术前显著下降,5min后恢复至术前水平;术中两组均有明显的呼吸抑制(RR<12次/min);两组患者术中OAA/S评分、睁眼时间无明显差异。[结论]静脉芬太尼复合异丙酚能为LEEP术患者提供良好的术中镇痛、镇静及遗忘效果,较单独使用异丙酚麻醉效果更佳,且不良反应少,安全性更高。     

Predictors of Absent High-grade Cervical Intraepithelial Neoplasia (CIN) in Loop Electrosurgical Excision Procedure Specimens of Patients with Colposcopic Directed Biopsy-Confirmed High-Grade CIN

Objective: To determine predictors of having cervical intraepithelial neoplasia (CIN) 1 or less in loopelectrosurgical excision procedure (LEEP) specimens of patients with colposcopic directed biopsy-confirmed CIN 2-3.Methods: Two hundred and eighty patients with colposcopic directed biopsy-confirmed CIN 2-3 who subsequentlyunderwent LEEP were enrolled in the retrospective study. Related clinical data were collected to determine the predictors ofCIN 1 or less in LEEP specimens. Results: CIN 1 or less in LEEP specimens was found in 71 (25.4%) of 280 patients.Multivariate logistic regression analyses demonstrated that nulliparity [OR (95% CI) = 3.375 (1.245-9.150)], lowgrade Papanicolaou (Pap) results [OR (95% CI) = 6.410 (2.877-14.280)] and low grade colposcopic impression[OR (95% CI) = 16.506 (5.844-46.632)] were significant risk factors of having CIN 1 or less in LEEP specimens. Neitherpersistent nor recurrent CIN 2-3 was detected in 71 patients who had CIN 1 or less in LEEP specimens. However,persistent or recurrent CIN 2-3 developed in 3 out of 209 (1.4%) patients with CIN 2-3 found in LEEP specimens.Conclusion: Approximately 25% of patients with CIN 2-3 in colposcopic directed biopsy specimens had CIN 1 or lessfound in LEEP specimens. Predicting factors of having CIN 1 or less in LEEP specimens were nulliparity, low gradePap results and low grade colposcopic impression.     

电圈切除术对宫颈病变诊断治疗价值的临床分析

目的评估宫颈电圈环切术(LEEP)对宫颈病变的诊断治疗价值。方法对169例宫颈病变患者行电子阴道镜下宫颈多点活检及LEEP术,将LEEP术前电子阴道镜下多点活检的诊断结果与LEEP术后病理诊断结果进行对照分析。结果与LEEP术前电子阴道镜下宫颈多点活检的诊断结果相比,169例LEEP术后病理诊断级别升高者有41例。电子阴道镜下宫颈多点活检诊断宫颈病变与最终诊断的符合率为75.7%(128/169)。电子阴道镜下多点活检与LEEP术后标本病理诊断有显著性差异(P<0.05)。结论LEEP术具有疗效好、操作简单、安全,术后并发症少、且可提供完整的病理标本等优点。对宫颈病变特别是慢性宫颈炎及宫颈上皮内瘤变(CIN)是1种非常理想的诊断、治疗手段。     

环型电切术治疗宫颈病变208例临床分析

目的 探讨环型电切术（LEEP）对宫颈病变的治疗效果。方法 经细胞学和阴道镜检查后，对208例患者行环型电切术（LEEP），并与同期微波治疗105例进行对照比较，术后随访半年至2年。结果 208例中，1次治愈202例，1次治愈率97，1％，有效率100．0％，在治疗效果与愈合时间上显著优于对照组。结论 对于宫颈糜烂、宫颈息肉，CINⅠ～Ⅲ级等官颈病变患者，环型电切术为1种安全有效的治疗方法。     

Risk Factors for Incomplete Excision after Loop Electrosurgical Excision Procedure (LEEP) in Abnormal Cervical Cytology

Objective: To investigate the risk factors related to incomplete excision after loop electrosurgical excision procedure (LEEP) in abnormal cervical cytology. Methods: This retrospective cohort study was performed during September 2010 to February 2017. The study population was patients with abnormal cervical cytology who treated by LEEP at Prapokklao hospital, Chanthaburi. From the medical records, data were collected include age, menopausal status, parity, body mass index, HIV infection, history of smoking, cervical cytology and characteristics of LEEP histopathology such as number of specimen, size and glandular involvement. Risk factors were investigated using multivariable risk ratio from risk ratio regression. Result: Five hundred cases of LEEP were done during this period and 322 cases were analyzed. Complete excision of the LEEP specimens found nearly half of the cases (46.9%). Multiple pieces of specimen was the risk factor for incomplete excision of LEEP (adjusted risk ratio [aRR] = 1.29, 95% confidence interval [CI] = 1.06-1.58; P = 0.013). Conclusion: The number of specimen from LEEP more than one piece was the risk factor for incomplete excision. Alternative methods such as cold knife conization (CKC), needle excision of the transformation zone (NETZ) or contoured loop excision of the transformation zone (C-LETZ) should be justified when all lesions could not be operated by single sweep.