子宫颈电圈切除术对123例宫颈上皮内瘤变的疗效研究

目的探讨宫颈电圈切除术(LEEP)手术方法和有关术后并发症的关系及其预防措施,手术后标本的观察处理原则。方法2005年9月～2008年9月采用LEEP对123例宫颈上皮内瘤变(CIN)患者进行治疗,对其疗效作回顾性分析。结果术前术后病理诊断一致占43.9%(54/123);术后病理诊断级别下降占52.0%(64/123),其中下降一级占25.6%,下降两级占19.2%,下降三级占8.3%;术后病理诊断级别上升占4.1%(5/123),其中上升一级占5.4%,上升两级占1.0%。宫颈管受累占8.1%(10/123)。合并单纯子宫内膜增生过长占22.8%(28/123)。手术切缘阳性4例,其中CINⅠ2例、CINⅡ、Ⅲ各1例。术后3个月细胞学检查为不典型鳞状上皮细胞占12.2%(15/123),其余均为正常。术中出血达10mL5例,92.1%(113/123)的患者术后第2～21天出现少量阴道血性分泌物。术后子宫颈管解剖狭窄4例,术后盆腔痛8例。术后半年无CIN占116例,治愈率为94.3%;宫颈CIN残留4例,占3.2%;第1年内复查发现CINⅡ持续3例。术后妊娠6例次,足月阴道分娩2例,4例现继续妊娠已达中晚期。早期妊娠人工流产6例,早孕延期流产1例,未发现早产及低出生体重儿。结论LEEP是治疗CIN的安全有效方法,只要掌握手术指征,规范手术步骤,注意术后病理观察,可获得满意疗效。

Objective To study the application of loop electrosurgical excision procedure （LEEP）, its complications and the prevention measures. Methods 123 cases with cervical intraepithelial neoplasia（CIN） treated by LEEP from September 2005 to September 2008 were analyzed retrospectively. Results The pereoperative diagnosis of 54cases （43.9%） were in accordance with the postoperative ones. The postoperative diagnosis were downgraded in 64 cases （52.0%）, and upgraded in 5 cases （4.1%）. Intraoperative bleeding amounted to 10 milliliters in 5 cases; 113 cases （92.1%） got small amounts of bloody vaginal discharges from the 2nd day to the 18th day after operation. 15 cases （12.2%） persented abnormal squamous cell in Pap smear 3 months after operation. 116 cases showed no abnormalities in 6 months. The cure rate was 94.3%. 3case with CIN 2 was found with persistence in 1 year. Postoperative pregnancy in all patients occurred 6 times, of them, 2 cases gave full-term child birth, 4 cases were in middle- late stage ofpergnancy now, 6 cases were performed induced abortion and 1 case with delayed abortion in early stage. Conclusion LEEP is a safe and effectiven procedure in treating CIN. Satisfactory results can be achieved by mastering surgicd indications and standard procedures and paying attention to postoperative pathology, accordance with the postoperativ ones. The postoperative diagnosis were downgraded in 108 cases.