宫腔镜宫颈病变电切术与宫颈环形电切术治疗宫颈上皮内瘤样病变Ⅰ级的对比研究

Comparison of Transcervical Resection and Loop Electrosurgical Excision for the Treatment of Grade Ⅰ Cervical Intraepithelial Neoplasia

目的比较宫腔镜宫颈病变电切术与宫颈环形电切术治疗宫颈上皮内瘤变Ⅰ级(CIN I)的临床疗效。方法将231例CIN I按门诊预约手术号奇偶数分为2组,分别采用宫腔镜宫颈病变电切术(transcervical resection of cervical lesion,TCRC)与宫颈环形电切术(loop electrosurgical excision procedure,LEEP)进行治疗,切除标本均送病理学检查并行人乳头状瘤病毒(HPV)-16及18型检测。结果TCRC组与LEEP组在手术时间[(14.1±2.2)minvs.(13.8±2.1)min]、创面感染率[1.7%(2/115)vs.1.7%(2/116)]、宫颈狭窄发生率[0.9%(1/115)vs.1.7%(2/116)]、治愈率[99.1%(107/108)vs.99.1%(108/109)]及复发率[0.9%(1/108)vs.0.9%(1/109)]差异无显著性(t=1.060,P=0.290;χ2=0.000,P=1.000;χ2=0.000,P=1.000;χ2=0.000,P=1.000;χ2=0.000,P=1.000);TCRC组创面愈合时间(5.0±0.6)周显著短于LEEP组(5.2±0.7)周(t=-2.331,P=0.021)。术前伴有严重宫颈黏膜炎患者的术后宫颈黏膜炎残留率差异无显著性[16.7%(2/12)vs.53.8%(7/13),Fisher's检验,P=0.097]。2组术后各1例残存病变持续存在者均为HPV-16和(或)18型感染。结论TCRC与LEEP是治疗CIN I的有效方法,但LEEP较TCRC易于掌握、便于普及。对于HPV-16和(或)18型阳性者,术后应加强随访观察。

Objective To compare the efficacy of transcervical resection （TCRC） and loop electrosurgical excision procedure （LEEP） for the treatment of cervical intraepithelial neoplasia grade Ⅰ（CIN Ⅰ ）. Methods A total of 231 CIN Ⅰ patients were divided into two groups according to their patient number to receive TCRC or LEEP. The resected specimens were sent for pathological diagnosis and human papilloma virus （ HPV）-16/18 test. Results No significant difference was found in the operation time [ （ 14. 1 ±2.2） min vs. （ 13.8 ± 2. 1 ） mini, rates of wound infection and cervical stricture[ 1.7% （2/115） vs. 1.7% （2/116） and 0.9% （1/115） vs. 1.7% （2/116）], and rates of cure and recurrence [99.1% （107/108） vs. 99.1% （108/109） and 0.9% （1/108） vs. 0.9% （1/109）] between the TCRC and LEEP groups （t=1.060, P=0.290; X^2 =0.000, P=1.000;X^2 =0.000, P=1.000;X^2 =0.000, P=1.000;X^2 =0.000, P=1.000）. In the TCRC group, the surgical wound was healed in（5.0±0.6） weeks, which was significantly shorter than that in the LEEP group [ （5.2 ± 0.7 ） weeks, t = -2.331 ,P = 0. 021 ]. The patients who had severe endocervicitis in both the groups had similar rate of residual endocervicitis[ 16.7% （2/12） vs. 53.8% （7/13）, Fisher＇ s test： P = 0.097 ]. In both the groups, one patient respectively showed residual lesion after the procedure, in whom HPV-16 and/or HPV-18 were detected. Conclusions Both TCRC and LEEP are effective for CINI. LEEP is easier to master than TCRC. Closed follow-up is essential of the with patients positive HPV-16 or -18.