宫颈电热圈环切术治疗不同性质和程度宫颈疾病511例效果观察

Efficacy of LEEP for Treating 511 Cases of Cervical Diseases of Different Degrees and Heterogeneity

目的探讨宫颈电热圈环切术(LEEP)治疗不同程度和性质宫颈疾病的手术方式和临床效果。方法回顾性分析经A、B、C、D(锥形式、环形蘑菇式、环形浅蘑菇式、削果皮样式)4种LEEP术式治疗的宫颈疾病511例的临床资料,其中宫颈上皮内瘤变(CIN)78例,宫颈柱状上皮异位(CCE)433例,观察临床效果和并发症的发生情况。结果随着LEEP术式由D→A,切除宫颈组织平均体积逐渐增大,术中平均出血量逐渐增加,平均宫颈愈合时间逐渐延长;80例行术前多点活检与术后行病理检查,术前、术后病理学检查结果符合率为90.0%;LEEP-A、B、C、D 4种术式的治愈率分别为100.0%、98.7%、100.0%、93.7%;CCE总治愈率为99.1%,CIN总治愈率为96.2%;术后宫颈塑形总满意率为94.5%;LEEP手术并发症主要包括出血、感染、宫颈管黏膜外翻、宫颈管狭窄。结论不同性质和程度的宫颈病变应采取不同的LEEP术式,达到既要治愈疾病又避免过度切除宫颈组织的目的,以保护宫颈功能,提高临床疗效。

Objective To investigate different loop electrosurgieal excision procedures （LEEP） and the efficacy for treating cervical diseases of different degrees and heterogeneity. Methods 511 patients with different cervical diseases E ingcluding 433 cervical columnar ectopy （CCE） and 78 cervical intraepithelial neoplasia （CIN） I were treated with four types of LEEP （ LEEP-A ： cut off like cone-shape ; LEEP-B ： mushroom-shape ; LEEP-C ： ring-shallow-mushroom-shape and LEEP-D： peeling cervical rind）. The efficacy and complications were retrospectively analyzed. Results The average external vulume of cervical resected tissue andblood loss, the cervical healing time gradually increased in the reverse order of LEEP D→A. In 80 patients with CIN, the conformity rate of pathological results after LEEP with multi spot-biopsy before LEEP was 90.0%. The efficacy of LEEP A, B, C and D was 100.0% , 98.7% , 100.0% , and 93.7% , respectively. The efficacy of CCE and CIN was 99.1% and 96.2% , respectively; the satisfaction rate for cervical outline after LEEP was 94.5%. The complications include bleeding, infection, cervical mucous membrane eversion, cervical canal stenosis. Conclusion Selection of LEEP operation procedure is dependent on the nature and degree of cervical diseases to minimize the excision of cervical tissue, to reduce the complications, and to maintain cervical function.