宫颈电热圈环切术在宫颈上皮内瘤变诊治中的价值

Utility of Loop Electrosurgical Excision Procedure in Diagnosis and Treatment of Cervical Intraepithelial Neoplasia

目的:探讨宫颈电热圈环切术(LEEP)在宫颈上皮内瘤样病变(CIN)诊断、治疗中的作用。方法:回顾性分析2003年10月～2007年12月术前诊断CIN行LEEP术者136例,自身对照比较阴道镜下多点活检及LEEP术后病理检查的结果。结果:136例CIN患者LEEP后病理诊断完全符合者46例(33.8%);不符合者90例(66.2%),其中80例(58.8%)LEEP后病理检查较阴道镜下多点活检程度轻,10例(7.4%)程度较重,浸润癌1例。LEEP切缘阳性率6.6%(9/136),手术并发症主要是术后出血,短期随访未发现复发病例。结论:LEEP治疗CIN安全有效、简单易行、并发症少、避免了二次手术和过度治疗,能保留患者的生育能力,在治疗的同时能进行诊断。宫颈锥切术后人乳头瘤病毒(HPV)持续阳性患者为复发的高危人群,应严密随访。

Objective： To explore the value of loop electrosurgical excision procedure （LEEP） in the diagnosis and treatment of cervical intraepithelial neoplasia （CIN） . Methods： 136 cases of CIN of LEEP demand were retrospectively analyzed from October 2003 to December 2006. The pathological results by LEEP were compared with the pathological ones by colposcopic multiple biopsy under the condition of auto control. Results： The LEEP pathological results were accordant with the pathological ones of colposcopic multiple biopsy in 46 cases （33.8%）. In the other 90 cases（44.2% ）, the pathological results of cervical conization were not accordant with the ones of colposcopic multiple biopsy, which showed that 80 cases（58.8% ） were in lower grade in the pathological results of cervical conization than in those of colposcopic multiple biopsy, and other 10 cases （7.4%）were in higher grade. Positive rate of LEEP margines were 6.6% （9/136）, and one case was diagnosed as cervical infiltrative carcinoma. No case of recrudescence was found during short - term follow - up survey. Conclusion ： LEEP is safe, effective, feasible and a cheap method in treatment of CIN with few implications, which can avoid repeating surgeries and treating excessively and retain reproductive potential of patient. On the other hand, diagnosis is done accompanied by treatment. The patients with persistent human papillomavirus （HPV） infection after LEEP are at risk of developing recrudescence who should be regularly followed up.