宫颈环形电切除术在治疗宫颈高度鳞状上皮内病变中的价值

The value of treating cervical intraepithetlial neoplasm with Loop Electrosurgical Excision Procedure

目的探讨宫颈环形电切除术(LEEP)治疗宫颈高度鳞状上皮内病变(≥CIN2)临床价值及术后随访途径。方法随机选取我院宫颈门诊,阴道镜下宫颈活检病理诊断≥CIN2患者113例,均行宫颈LEEP治疗,切除术后标本均送病理学检查,并利用HPV及阴道镜进行术后随访。结果 LEEP术前术后病理结果一致者54例,级别下降者34例,级别上升者25例。其中级别上升者有8例为宫颈早期浸润癌,术前高危型HPV感染102例,其中单独感染68例,复合感染34例。术后6个月HPV转阴率85.29%、12月转阴率97.06%,差异有统计学意义(P<0.05)。持续性高危型HPV感染者,阴道镜下宫颈活检术+宫颈管搔刮发现病变残留占40%。结论 LEEP治疗宫颈高度鳞状上皮内病变安全经济有效,但由于宫颈病变的多灶性,术后可采用高危型HPV监测联合阴道镜下活检+宫颈管搔刮术,以尽早发现病变残留和(或)复发。

Objective Discussion of loop electrical excision （LEEP） height of cervical squamous intraepithelial lesions （≥CIN2） clinical value of postoperative follow-up approach.Methods Random select outpatient Department of our hospital of cervical,cervical biopsy under colposcopy ≥CIN2 in 113 patients with pathologic diagnosis,are treated by cervical LEEP, specimens were sent after resection of pathological examination, and postoperative follow-up colposcopy and HPV.Results LEEP preoperative postoperative pathological result in 54 cases, Level droopped in 34cases,level increased in 25 cases.The level rose 8cases of early invasive carcinoma of cervix. 102 cases of preoperative high-risk HPV infection, of which 68 cases alone, 34 cases of compound infection. HPV negative conversion rates for 6 months after surgery （85.29%）, December negative conversion rates （97.06%）, the differences are significant. Living with persistent high risk HPV, cervical biopsy under colposcopy ＋ tube curettage found residual lesions of the cervix （eight-ftfteenths） 40%. Conclusion LEEP on cervical squamous intraepithelial lesions of the highly secure cost-effective, but due to cervical pathological changes of multifocal, after can be highrisk HPV monitoring combined with curettage biopsy under colposcopy ＋ cervical tube, to early detection of residual lesions and （or） relapse .