聚焦超声和激光加电凝治疗HPV高危亚型感染的CIN Ⅰ疗效比较

Focused ultrasound vs laser coagulation in treatment of cervical intraepithelial neoplasia Ⅰ with high-risk HPV infection:report of 618 cases

目的比较聚焦超声和激光加电凝治疗伴HPV高危亚型感染的CINⅠ的临床疗效。方法对618例HPV高危亚型感染的CINⅠ患者按随机数字表法分组,分别接受CZF超声波和激光加电凝治疗,其中聚焦超声组320例,激光加电凝组298例,在治疗前和治疗后6个月进行阴道镜下活检和HPV检测,评价其有效性和安全性。结果 2组术中出血差异无统计学意义,聚焦超声组术后阴道流血、阴道流液量均显著少于激光加电凝组(P<0.05)。治疗后6个月,聚焦超声组随访300例,292例CINⅠ消退,治愈率97.3%;200例HPV高危亚型感染全部转阴,清除率66.7%,40例部分转阴,有效率80%。激光加电凝组随访290例,CINⅠ治愈280例,治愈率96.6%;185例HPV高危亚型感染全部转阴,清除率63.8%,30例部分转阴,有效率74.1%。2组组间比较,CINⅠ治愈率与HPV清除率差异无统计学意义;2组组内比较,CINⅠ的消退与HPV清除差异均有统计学意义,且均呈正相关(P<0.05,r=0.175 9、0.147 3)。结论聚焦超声和激光加电凝治疗对治疗CINⅠ及HPV高危亚型感染的清除均疗效显著且相当,但聚焦超声术后阴道流血及排液更少。

Objective To evaluate and compare the clinical therapy efficacy of focused ultrasound and laser coagulation in the treatment of cervical intraepithelial neoplasia（CIN） Ⅰ with high-risk subtypes of HPV infection.Methods A total of 618 cases of CIN Ⅰwith high-risk types of HPV infection who were treated in our department from April 2006 to April 2010 were prospectively randomized into focused ultrasound group（n=320） and laser power coagulation group（n=298）.The effectiveness and safety were evaluated by biopsy and HPV detection before and in 6 months after treatment.Follow-up were carried out in 2,6 and 12 months after treatment.Results There was no significant difference in blood loss between the 2 groups.Postoperative vaginal bleeding and vaginal fluid were significantly lesser in focused ultrasound than in laser coagulation group（P0.05）.In the first 6 months after treatment,among the 300 cases with follow-up out of focused ultrasound group,there were 292 cases of CIN Ⅰ subsided,with a cure rate of 97.3%.And 200 cases had high-risk types of HPV entire negative,with a clearance rate of 66.7%,and 40 cases were partial negative,with an effective rate of 80%.Among the 290 cases of laser coagulation who were followed up,CIN Ⅰ cured in 280 cases,with a cure rate of 96.6%;185 cases of high-risk types of HPV infection were entire negative,with a clearance rate of 63.8%,and 30 cases were in the partial negative,with an effective rate of 74.1%.There was no significant difference in the cure rate of CIN Ⅰ and the clearance rate of HPV between the 2 groups.Significant correlation was found between the regression of CIN Ⅰand the clearance of HPV in the 2 groups（P0.05,r=0.175 9 for focused ultrasound group and 0.147 3 for laser coagulation group）.Conclusion In the clearance of high-risk HPV types and CIN Ⅰ,the effectiveness of focused ultrasound treatment and laser coagulation treatment are very significant and have no significant difference,but the later has less colporrhagia and vaginal discharge after treatment.