应用子宫颈电圈切除术诊治子宫颈上皮内瘤样变的近期观察

Loop Electrosurgical Excision Procedure: A Review of Our Recent Experience

目的：总结应用子宫颈电圈切除术（ＬＥＥＰ）诊断及治疗子宫颈上皮内瘤样变（ＣＩＮ）的近期效果，探讨病变持续存在及复发的因素。方法：对２５６例ＣＩＮ２，３患者应用ＬＥＥＰ术，术后进行阴道镜及细胞学复查。结果：ＣＩＮ２，３共２３７例，治愈２２６例，治愈率为９５．４％；宫颈病变持续存在１１例，为４．６％，其中手术切缘无病变累及者６例，有病变累及者５例；发生手术并发症８例，为３．１％；术后复发８例；手术切缘有无病变累及者各４例。ＬＥＥＰ术切除组织中无ＣＩＮ病变者１８例，为７．６％。术后确诊为宫颈微小浸润癌１１例。结论：应用ＬＥＥＰ术诊治ＣＩＮ的疗效较高，并可用于微小浸润癌的诊断。手术切缘有病变累及是ＣＩＮ病变持续存在的因素。

Objective:To investigated whether persistence or recurrence of cervical intraepithelial neoplasis (CIN) is associated with an involved excisional margin during loop electrosurgical excision procedure (LEEP). Methods:The records of 256 consecutive LEEP were studied. After LEEP, all patients were followed up by colposcopy and cytology at 4 to 6 month intervals for at least two years. A patient was classified as having persistent disease if SIL was seen within one year of treatment or recurrent disease if SIL was detected after one year of treatment. All relevant patient details including cytology, colposcopy findings, treatment histology, complications, recurrence or persistence of disease entered into a computer database. Results: Complications occurred in 8 patients (3.1%). LEEP was successful in treating 226 patients (95.4)% Eleven patients (4.6%) had persistent SIL. Involvement of the resetction margin was a significant risk factor for persistent disease (3.1% for uninvolved margins vs 11.4% for involved margins, P <0.05). Similarly, recurrent disease occurred in 9.1% of patients with involved resection margins vs 2.1% with uninvolved margins ( P <0.05).Eleven patients (4.3%) had microinvasive carcinoma. Only 3 were identified by colposcopy and directed biopsy. Conlusion: LEEP is established as a safe and efficacious method for the treatment of CIN, long term morbidity including the effect on subsequent fertility must be observed.