阴道镜检查联合LEEP刀治疗宫颈上皮内瘤样病变在新疆地区的临床应用

Application of Vaginoscopy Combined with LEEP Electrosurgical Excision for Cervical Intraepithelial Neoplasia in XinJiang Area

目的评价阴道镜检查联合高频电波刀(LEEP刀)治疗宫颈上皮内瘤样病变(cervical intraepithelial neoplasia,CIN)的临床价值。方法 2008年1月～2009年6月对228例宫颈液基薄层细胞学检查(liquid-based thinprep cytology test,TCT)为CIN的患者应用阴道镜检查联合LEEP刀治疗,对比分析阴道镜下宫颈活检的病理与LEEP术后病理结果。结果 LEEP刀治疗CIN手术时间(6.3±2.5)min,术中出血量(7.3±4.1)ml,术后愈合时间(6.4±0.6)周。下腹胀痛不适发生率为82.0%(187/228),术后阴道不规则出血发生率为90.8%(207/228),无一例发生宫颈管狭窄。阴道镜下宫颈活检的病理与LEEP术后病理诊断相符合208例,符合率为91.2%(208/228);升级9例,占4.0%(9/228);降级11例,占4.8%(11/228)。177例随访2～24个月,平均13.4月,9例(5.1%,9/177)病变残留,其中1例切缘病变为CINⅡ级行2次LEEP刀手术,其余8例病变轻定期随访至术后12～24个月,TCT、阴道镜检查均正常;2例(1.1%,2/177)术后10个月复发,均为CINⅠ级,物理治疗后随防至正常;余166例(93.8%,166/177)治愈。结论阴道镜检查联合LEEP刀治疗CIN安全、高效。

Objective To evaluate the clinical value of vaginoscope and LEEP electrosurgical excision for cervical intraepithelial neoplasia （CIN）. Methods The clinical data of 228 patients with CIN,who were diagnosed by TCT from January 2008 to June 2009,were analyzed retrospectively. A comparative analysis of pathologic findings was made after LEEP and vaginoscopic biopsy. Results The mean operation time for LEEP was （6.3±2.5） min,and the mean intraoperative blood loss was （7.3±4.1） ml. The mean healing time of the surgical wound was （6.4±0.6） weeks. After the operation,187 of the 228 patients （82.0%） had abdominal complaints,207 cases （90.8%） showed irregular vaginal bleeding,whereas no patient had cervical stenosis. In 208 of the patients （91.2%） the results of vaginoscopic biopsy were identical to that of the post-LEEP pathological examination; in 9 cases （4.0%）,post-LEEP pathological examination showed more advanced lesion than that observed by vaginoscopic biopsy,while in the other 11 cases （4.8%）,vaginoscopic biopsy showed more advanced diseases. Follow-up was achieved in 177 patients for 2 to 24 months with a mean of 13.4 months. Nine of the patients （5.1%,9/177） showed residual CIN tissues,one of them received a second LEEP because of CIN II detected at cut margin,the other eight patients received follow-up for 12 to 24 months,during which both TCT and vaginoscopy showed normal results. Recurrent CIN I was detected in two patients （1.1%,2/177） in 10 months after the operation,physical therapy was then carried out until follow-up examination showed normal results. The curative rate in this series was 93.8%（166/177）. Conclusions Vaginoscope combined with LEEP electrosurgical excision is safe and effective for CIN.