高频电波刀治疗CINⅡ～Ⅲ级的临床观察

Clinical observation of the loop electrosurgical excision procedures to treat CINⅡ～Ⅲ

目的探讨高频电波刀宫颈环形电切除术(Loop electrosurgical excision procedure,LEEP)对宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅱ～Ⅲ级患者诊断及治疗的临床价值。方法对266例CINⅡ～Ⅲ级患者行LEEP手术治疗,并进行为期2～5年的随访,对阴道镜下多点活检病理结果与LEEP术后标本病理检查结果比较,病变残留和复发等情况进行分析总结。结果 LEEP术后标本病理检查结果有22例CIN级别高于活检病理结果,病理检查不符率为8.27%。6个月总的治愈率为92.97%,1年内病变残留率4.30%,2年复发率为2.34%,3年复发率为0.39%,4、5年无复发。其中CINⅡ164例,6月治愈率97.52%,1年内病变残留率1.24%,2年复发率为1.24%,3、4、5年的复发率均为0。CINⅢ102例,6月治愈率为85.26%,1年内病变残留率9.47%,2年复发率4.21%,3年复发率1.05%,4、5年复发率均为0。CINⅡ与CINⅢ在治愈率、病变残留率方面比较,差异有统计学意义(P<0.05),复发率比较差异无统计学意义(P>0.05)。结论 LEEP在CIN的诊断及治疗中有重要价值,可减少CIN的漏诊;对于CINⅡ～Ⅲ级患者的治疗是安全、有效的;但需长期随访,尤其是术后2年。

Objective To study the effectiveness of the loop electrosurgieal excision procedures（LEEP） in diagnosis and treatment for cervical intraepithelial neoplasia（CIN） Ⅱ～Ⅲ. Methods Totally 266 patients with CIN Ⅱ～Ⅲ treated by LEEP were followed up for 2 - 5 years in Department of Gynaecology and Obstetrics, Siehuan Provincial People＇ s Hospital. The results of LEEP conization and colposeopic multiple biopsies were compared. The incidences of residual pathological changes and the recurrence were analyzed prospectively. Results The pathological results of LEEP showed that CIN grade of 22 cases was higher than that of pathological examination results which the coincidence rate was 91. 73%. The cure rate of first six months was 92.97%, residual rate was 4.30% in 1^st - year and the recurrence rate of CIN was 2.34% , 0.39% in the 2^nd , 34 - year respectively while the recurrence rate of the 4^th and 5^th - year was none. According to the grade of CIN, the overall cure rate was 97.52% arid residual lesion was identified in 1.24% patients in the first year, the recurrent rate occurred in 1. 24% patients in the 2^rd -year, while none was in the 3^rd, 4^th and 5^th year in 164 cases of CIN Ⅱ. In 102 cases of CIN Ⅲ, the overall cure rate was 85. 26%, the residual rate occurred in 9.47% patients in Is＇ year, the recurrent rate occurred in 4.21% patients in the 2^rd - year, 1.05% in the 3^rd - year, while none in the 4^th and 5^th year. The cure rate and residual rate was significam difference（P 〈 0.05） between CIN Ⅱ and CIN Ⅲ while recurrence rate was no difference （ P 〉 0.05 ） between CIN Ⅱ and CIN Ⅲ. Conclusion LEEP is important for the diagnosis and treatment of CIN. LEEP is a kind of effective and safe method for the treatment of CIN Ⅱ～Ⅲ. The patients need to be followed for a long time, especially in first two years.