两种电切术治疗宫颈上皮内瘤变的疗效比较

Comparison of treatment effects on cervical intraepithelial neoplasia by two kinds of electrosurgical excision

目的比较宫腔镜宫颈病变电切术(TCRC)与宫颈环型电切术(LEEP)治疗宫颈上皮内瘤变(CIN)的临床疗效。方法将359例CIN患者随机分为两组,分别采用TCRC(TCRC组)与LEEP(LEEP组)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组的手术时间、创面愈合时间、术后阴道排液及出血持续时间、治愈率和复发率分别为(14.3±2.2)min、(5.7±0.3)周、(17.3±3.1)d、97.6%和1.2%,LEEP组分别为(13.9±2.2)min、(5.6±0.3)周、(18.1±3.7)d、96.9%和1.8%,两组间差异均无统计学意义(P值均>0.05)。TCRC组术中出血量为(5.6±1.9)mL,显著少于LEEP组的(10.0±4.8)mL(P<0.05)。术后4例残存病变持续存在者及9例病变复发者均为HPV-16和(或)18型感染。结论TCRC及LEEP是治疗CIN的有效方法,TCRC治疗CIN优于LEEP,但LEEP较TCRC易于掌握、便于普及。术后应加强对于HPV-16和(或)18型阳性者,随访观察。

Objective To compare the clinical effects of transcervicat resection of cervical lesion through hysteroscopy（TCRC） and loop electrosurgical excision procedure（LEEP）in treatment of cervical intraepithelial neoplasia（CIN）. Methods A total of 359 CIN patients were randomly divided into two groups, namely TCRC and LEEP groups. The specimens were sent for pathological diagnosis and human papilloma virus （HPV）-16/18 test. Results The operative time, wound cure time, postoperative vagina flowing and bleeding duration, curative rate and recurrence rate in TCRC group were（14.3±2.2） min, （5.7±0.3） w, （17.3±3.1） d, 97.6%, and 1.2%,respectively; inLEEP group were （13.9±2.2） min, （5.6±0.3） w,（18.1±3.7） d, 96.9%, and 1.8% ,respectively （all P〉0.05）. Four cases had residual lesions and 9 had lesion recurrence, all infected by HPV-16/18. Conclusion Both TCRC and LEEP are effective therapies for CIN. TCRC is more effective than LEEP in clinical effect; however, LEEP is easier to perform and popularize than TCRC. Patients positive of HPV-16 or 18 should be closely followed up.