高频电波刀治疗宫颈疾病的临床价值及术后HPV检测的临床意义

目的:探讨高频电波刀(LEEP)治疗宫颈疾病的临床价值及术后HPV检测的临床意义。方法:回顾性分析2006年10月~2009年3月在武汉市妇女儿童医疗保健中心妇产科接受LEEP手术治疗的139例患者的术中出血量、术后病理结果及随访情况。结果:139例患者的术中平均出血量12.60 m l(2~80 ml)。术前术后病理级别一致者89例(64.03%),级别上升者26例(18.71%),级别下降者24例(17.27%)。术后随访12~18月98例,术后病理检查切缘阳性6例(4.23%),其中4例复查HPV-DNA阳性而行二次手术,另外2例HPV-DNA阴性随访2年无病灶复发;3例(2.16%)术后发生宫颈粘连(CINⅡ1例、CINⅡ2例),其中1例伴宫颈狭窄;TCT复查为炎症9例(6.47%),HPV-DNA阳性;1例术后复查为CINⅡ同时HPV-DNA阳性,应本人要求行全子宫切除术,术后病检未见癌变。结论:高频电波刀对诊断和治疗宫颈疾病有较高的临床价值。若正确掌握手术指证,规范手术操作步骤,则不影响病理学诊断,并可弥补阴道镜下活检的局限性。而术后HPV检测对预测病灶残留和复发有重要的临床意义。

Clinical value of LEEP in treatment of cervical diseases and clinical significance of postoperative HPV detection

Objective:To explore the clinical value of LEEP in treatment of cervical diseases and clinical significance of postoperative HPV detection.Methods:The intraoperative blood loss,postoperative pathological results and follow up results of 139 patients with cervical diseases receiving LEEP in the hospital from October 2006 to March 2009 were analyzed retrospectively.Results:The intraoperative blood loss was 12.60 ml(2~80 ml) on average;89 cases(64.03%) had the same pathological grades before and after operation,26 cases(18.71%) graded up,24 cases(17.27%) graded down;98 cases were followed up for 12~18 months,6 cases had positive margin which were confirmed by postoperative pathological examination,4 cases had positive HPV-DNA after reexamination,then secondary operation was conducted,and no recurrence was found in the other two cases with negative HPV-DNA after follow-up for two years;postoperative cervical adhesion occurred in 3 cases(2.16%)(1 case of CINⅠ and 2 cases of CINⅡ),including 1 case with cervical stenosis;9 cases(6.47%) with positive HPV-DNA were diagnosed as inflammation after TCT reexamination;1 case with positive HPV-DNA were diagnosed as CINⅡ,total hysterectomy was conducted as requested,no carcinogenesis was found during postoperative pathological examination.Conclusion:LEEP is a valuable method for diagnosis and treatment of cervical diseases.Grasping proper operative indications and normative operative procedures do not affect pathological diagnosis and can overcome the limitations of biopsy under colposcope;postoperative HPV detection has an important clinical significance to predict residual lesions and recurrence.