宫颈电圈切除技术在宫颈疾病诊断和治疗中的应用

The Clinical Application of LEEP on Diagnosis and Treatment of Disease of Cervix

目的探讨宫颈电圈切除技术(LEEP)在宫颈疾病诊断和治疗中的应用价值。方法选择经宫颈"三阶梯"诊断程序诊断的中、重度宫颈炎,低、高度宫颈上皮内病变〔宫颈上皮内瘤样病变(CIN)、原位癌(CIS)〕共262例,经LEEP行锥切术治疗,自身对照阴道镜多点活检结果,观察疗效及并发症发生情况。结果262例患者LEEP病理结果与阴道镜下多点活检病理结果符合率为:炎症92.3%(168/182)、息肉100.0%(10/10)、CINⅠ级71.1%(22/31)、CINⅡ级12/20(60.0%)、CINⅢ级54.5%(6/11)、CIS33.3%(2/6),总符合率为83.97%(220/262),不符合42例(16.03%)。LEEP发现早期浸润癌,行广泛性子宫切除术2例;因CINⅢ级及CIS行全子宫切除8例。65例患者在LEEP术后24个月的随诊中未发现宫颈细胞学异常,其中8人次妊娠。LEEP主要的手术并发症是出血(5.34%)。结论LEEP在诊治CIN中具有重要的价值,可弥补阴道镜的不足。对于患有CIN的育龄妇女,宫颈锥切是适当的治疗。

Objective To discuss the application of the loop electrosurgical excisional procedure （LEEP） in diagnosis and treatment of disease of cervix. Methods There are 262 cases who are diagnosed as moderate,severe cervical inflammation and different degree cervical intraepithelial neoplasia by the three-step screening approach. To observe the curative effect and complication ,we analyzed and comparatived the pathology results between cervi- cal conization and colposcopic multiple biopsies. Results Of the 262 case,the results of 220 case（83.97% ）between cervical conization and colposcopic multiple biopsies were coincident,they are 92.3% （168/182）inflammation,100.0% （10/10）polyp,CIN Ⅰ 71.1% （22/31） ,CIN Ⅱ 12/20（60.0%） ,CIN Ⅲ54.5% （6/11） and CIS 33.3% （2/6）, that of other 42cases （ 16.03% ）were discordant. 2 invasive carcinoma cases were diagnosed by LEEP and radical hysterectomy was performed ,8 cases were treated by panhysterectomy for CIN Ⅲ and CIS. 65 cases operated with LEEP were not cytology abnormal in 24 months followed-up period, and there were 8 times pregnancy. Hemorrhage was the main postoperative complication of LEEP（5.34% ）. Conclusion LEEP plays a very important role in diagnosis and treatment of CIN. It can make up the defect of colposcopy. Cervical competenceervical conization of LEEP is a gnod way for the women with CIN and desired childbearing.