子宫颈环形电切术与CO_2激光汽化治疗宫颈上皮内瘤变2级的价值医学

Value-based Medicine of Loop Electrosurgical Excision Procedure and CO_2 Laser Vaporization for Cervical Intraepithelial Neoplasia 2

目的多中心研究评价子宫颈环形电切术(loop electrosurgical excision procedure,LEEP)与CO2激光汽化治疗宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)2级的疗效、费用及术后生活质量。方法 选取宫颈活检病理证实的CIN2患者338例,分别采用LEEP术和CO2激光汽化治疗,术后3、6及12个月进行随访,记录疗效、并发症及费用,术后12个月填写生活质量问卷。结果 LEEP组195例患者,病变缓解174例(89.2%)、病变复发7例(3.6%);激光组143例患者,病变缓解124例(86.7%)、病变复发1例(0.70%),两组疗效比较差异无统计学意义(P>0.05)。LEEP组术后痊愈时间、手术次数、术中出血量及平均治疗费用与激光组比较差异有统计学意义(P<0.05),两组术后生活质量评分差异无统计学意义(P>0.05)。结论 LEEP与CO2激光汽化治疗CIN2是安全而有效的方法 ,治疗前疾病状态的准确评估及术后规范随访对CIN2的治疗具有重要作用。同时,妇科医生应加强对患者生活质量的重视。

Objective To compare the effectiveness,cost,and quality of life between loop electrosurgical excision procedure（LEEP）and CO2 laser vaporization in treating cervical intraepithelial neoplasia 2（CIN2）.Methods Totally 338 women with colposcopic-histopathologically confirmed CIN2 were enrolled in this study,of whom 195 underwent LEEP（LEEP group）and 143 underwent CO2 laser vaporization（laser group）.They were followed up 3,6,and 12 months after treatment.A questionnaire of EORTC QLQ-C30 and QLQ-CX24 were filled out at 12 months follow-up.Results In LEEP group,CIN was cured in 174 patients（89.2%）and relapsed in 7（3.6%）.In laser group,CIN was cured in 124 patients（86.7%）and relapsed in 1 patient（0.70%）（both P0.05）.The recovery time,number of operation,bleeding volume,and costs were significantly different between these two groups（P0.05）.Women treated with LEEP showed relatively identical quality of life compared with those treated with CO2 laser vaporization.Conclusions Both LEEP and CO2 laser vaporization are effective and reliable for the treatment of CIN2,while pre-operative evaluations and post-operative follow-up are essential.Attention should also be paid to the post-operative quality of life.