LEEP术对CIN治疗效果的临床观察

Clinical observation on the curative effect of LEEP for CIN

目的:研究LEEP术(宫颈环形电切术)在治疗CIN(宫颈上皮内瘤样病变)中的效果,并进一步探讨HPV(人乳头瘤病毒)16,18对CIN预后的影响。方法:阴道镜检查宫颈异常或TCT异常者行HPV16,18DNA检测,并行阴道镜下宫颈活检,确诊为CIN的患者共105例,行LEEP术后送病检。术后3个月检查宫颈恢复情况,6个月复测HPV16,18及TCT,对于宫颈CINⅡ～Ⅲ建议行阴道镜下宫颈活检。结果:LEEP术并发症少,术后6月复查,87.10%的CINⅡ～Ⅲ转为慢性宫颈炎,术后CIN转归与术前比较统计学有显著差异(P<0.05);LEEP术前术后HPV16,18感染统计学有显著差异(P<0.05);LEEP术后CIN的复发与术前是否有HPV16,18感染差异无统计学意义(P>0.05);LEEP术后复发的CIN中,HPV16,18持续感染明显多于HPV16,18转阴的病例,统计学有显著差异(P<0.05)。结论:LEEP治疗CIN安全有效,在清除HPV16,18中有一定作用,值得临床推广。LEEP术后CIN复发与术前HPV16,18的感染关系不大,HPV16,18的持续感染才是CIN复发的高危因素,术后应加强随访。

Objective：To study the effect of loop electrosurgical excision procedure（LEEP） in treatment of cervical intraepithelial neoplasia（CIN）,further explore the effects of HPV16 and HPV 18 on the prognosis of CIN.Methods：The cases with cervical abnormality detected by colposcope or abnormal TCT received HPV16 and HPV 18 DNA detection,and cervical biopsy under colposcope was conducted,105 cases were diagnosed as CIN definitely,pathological examination was carried out after LEEP.The recovery of cervix was examined at 3 months after surgery,HPV 16,HPV 18 detection and TCT were conducted at 6 months after surgery,the cases with CIN Ⅱ~Ⅲ were advised to receive cervical biopsy under colposcope.Results：The complications of LEEP were rare.During the reexamination at 6 months after surgery,87.10% of the cases with CINⅡ~Ⅲ converted to chronic cervicitis,there was significant difference in the prognosis of CIN before and after surgery（P0.05）.There was significant difference in infection rates of HPV 16 and HPV 18 before and after LEEP（P0.05）.There was no significant difference in the recurrence rate of CIN after LEEP between the cases with HPV 16,HPV 18 infection before LEEP and the cases without HPV 16,HPV 18 infection before LEEP（P0.05）.Among the cases with recurrent CIN after LEEP,the proportion of cases with continuous HPV 16 and HPV 18 infection was significantly higher than that of cases with negative HPV 16 and HPV 18（P0.05）.Conclusion：LEEP is safe and effective in treatment of CIN,which plays a certain role in clearance of HPV 16 and HPV 18,and the method is worthy to be popularized.The prognosis of CIN after LEEP is not related to HPV16 and HPV 18 infection,continuous infection of HPV16 and HPV 18 is a high risk factor of high incidence of CIN,follow-up after surgery should be enhanced.