宫颈电圈环切术中颈管黏膜环切预防宫颈柱状上皮外移效果分析

Loop electro-surgical excision procedure in prevention of cervical columnar ectopy:A stady of cervical canal mucosa excision

目的探讨宫颈电圈环切除术（LEEP）在治疗上皮内瘤样病变（CIN）时颈管黏膜环切对预防术后宫颈柱状上皮外移的作用。方法 156例CIN患者在行LEEP术前采用抽签方法分为两组,其中对照组78例选择Fisher电极行LEEP锥切;试验组78例在用Fisher电极切除宫颈病变后,再用小环形电极伸入颈管切除颈管黏膜0.5-0.8 cm。术后1、2、3及4周随访阴道流血、分泌物及创面恢复情况,术后3个月随访宫颈柱状上皮外移的发生率及宫颈粘连狭窄的发生率。比较两组手术时间、术中出血量、术后出血时间、术后宫颈柱状上皮外移的发生率及宫颈粘连狭窄的发生率。结果试验组术后4周及术后3个月宫颈柱状上皮外移的发生率分别为6.41%、2.56%,低于对照组24.36%、17.95%,差异有统计学意义（P〈0.05）;两组手术时间、术中出血量、术后出血时间和术后宫颈粘连狭窄发生率的差异均无统计学意义（P〉0.05）。结论 LEEP锥切术中颈管黏膜环切可有效预防术后宫颈柱状上皮外移的发生。

Objective To study the effect of cervical canal mucosa excision in the prevention of cervical columnar ectopy in patients with cervical intraepithelial neoplasia by loop electro-surgical excision procedure（LEEP）.Methods Prospective randomized control trail was performed in 156 patients with cervical intraepithelial neoplasia（CIN）.The 78 patients in control group underwent cervical conization by Fisher electrode.Cervical canal mucosa was excised for about 0.5-0.8 cm with a small ring electrode in test group after cervical conization.Follow-up was performed 1,2,3,4 weeks and 3 months after operation respectively.Results There was no significant difference in operation time,bleeding volume,bleeding time,rate of cervical adhesion and stenosis between the two groups（P0.05）.Incidence of cervical columnar ectopy in test group in the 4th week and 3rd month（6.41%,2.56%）was lower than that in control group（24.36%,17.95%）respectively.There was significantly difference between the two groups（P0.05）.Conclusion Cervical canal mucosa ring excision in LEEP can effectively prevent postoperative cervical columnar ectopy.