环形电切术治疗宫颈上皮内瘤变的效果研究

目的：探讨宫颈环形电切术（LEEP）对宫颈上皮内瘤变（CIN）的诊断和治疗效果,术中、术后并发症的防治及预后。方法：对洛阳东方医院就诊的123例CIN患者进行LEEP手术并对术中、术后情况及其疗效进行回顾性分析。结果：阴道镜下宫颈活检与LEEP手术病理诊断相符的65例（52.8%）;术后诊断级别下降50例（40.7%）;而诊断级别上升8例（6.5%）,其中微小浸润癌1例。96例（78.0%）宫颈标本边缘病理学检查未见CIN病变;27例（22%）宫颈标本边缘CIN病变检测阳性或不能指定（由于电灼对细胞的破坏而影响诊断）,其中CIN病变残留患者为3例,复发患者为2例;而在96例（78.0%）宫颈标本边缘无CIN病变累及患者中,仅有1例CIN病变残留,无复发患者。123例中,首次术后治愈117例（95.1%）;4例（3.3%）患者发现残留CIN病变,2例（1.6%）患者术后复发;11例（8.9%）患者出现术中、术后并发症。结论：LEEP治疗CIN快速安全、复发率低、术后并发症少,可以弥补阴道镜下宫颈活检的不足,是目前治疗CIN的最佳方法。但要掌握手术指征,规范手术操作,注意标本边缘的病理检查结果。

Assessment of Effect of Cervical Intraepithelial Neoplasia with LEEP

Objective：To discuss the effectiveness and safety of loop electrosurgical excision procedure（LEEP）in diagnosis and management of cervical intraepithelial neoplasia （CIN） ,and its complications and the prevention measures. Methods ：LEEP was performed in an outpatient of colposcopie clinic. Records of 123 patients treated between Jan 2008 and Sep 2009 were analyzed retrospectively. Results ：The preoperative diagnosis of 65 cases （52.8%） were in accordance with the postoperative ones. The postoperative diagnosis were downgraded in 50 cases （40.7%） ,and upgraded in 8 eases （6.5%） which including 1 pacient of microinvasion. Clear resection margin of lesion in cervix was noted in 96（78.0%） patients. Unclear margins were appeared in 27（22%） patients including cases of resection margin positive and resection margin undetermined,in which the residual CIN occurred in 3 patients. In 1 patient with the resection margin clear. Re- currence CIN occurred in 2 patients with the unclear margins ,none of the patients with the resection margin clear. The cure rate in this study was 95.1% after first LEEP done. The residual CIN was identified in 4（3.3%） patients. The recurrence CIN occurred in 2 （1.6%） patients. Complications of LEEP occurred in 11 patients in this study. Conclusions：LEEP is a kind of safe and effective method for the treatment of cervical intraepithelial neoplasia. LEEP is more reliable than colposcopic multiple biopsy in diagnosing CIN. The status of resection margin should be concerned. Satisfactory results can be achieved by mastering surgical indications and standard procedures.