轻度宫颈上皮内瘤样病变高强度聚焦超声治疗的转归研究

Study of high intensity focused ultrasound in cervix intraepitheliar neoplasia grade I prognosis

目的通过比较高强聚焦超声（HIFU）治疗和未予任何干预措施的轻度宫颈上皮内瘤样病变（CIN Ⅰ）的转归情况，探讨HIFU对CIN Ⅰ的疗效。方法治疗组155例CIN Ⅰ患者应用HIFU进行治疗，自实施治疗后开始随访；对照组548例CIN患者自阴道镜下宫颈活检病理确诊开始随访。随访时间为6个月、12个月、24个月、36个月，随访方法为每次随访时行宫颈液基细胞学检查（LCT）和宫颈脱落细胞中高危型人乳头瘤病毒病毒（HR—HPV）检测，LCT检测结果为意义不明的不典型鳞状上皮细胞伴HR-HPV阳性，或LCT≥低度鳞状上皮内瘤样病变的妇女，行阴道镜下宫颈活检病理诊断，根据LCT、HRHPV及病理结果确定病变转归。结果①治疗组与对照组随访至36个月时累积失访率分别为18．66％和10．22％。②治疗组在随访6个月、12个月、24个月及36个月时的累积逆转率分别为77．51％、80．38％、86．12％和88．28％，逆转病例数随治疗后时间延长呈逐步上升趋势；累积持续率分别为33．01％、22．97％、9．33％和1．44％，呈逐步下降趋势。⑧治疗组与对照组的逆转率均随观察时间延长而增加，随访至6个月、12个月、24个月及36个月时两组比较差异均有统计学意义（P均〈0．05）；病变持续率在治疗组与对照组随观察时间延长均呈下降趋势，其中6个月、12个月及24个月时两组间差异有统计学意义（P〈0．05），而36个月时两组间差异无统计学意义；治疗组与对照组进展率比较差异有统计学意义（P〈0．05）。结论对于有干预指征的CIN Ⅰ，HIFU具有使宫颈局部无坚硬瘢痕的优点，而且可促进病变的逆转，减少病变持续率，并阻断其进一步发展为癌前病变。

Objective To evaluate the effectiveness of cervical intraepitheliar neoplasia grade Ⅰ （CIN Ⅰ ） after treated by high intensity focused ultrasound （HIFU） Ⅰ.Methods 155 CIN Ⅰ cases in treatment group started following after HIFU method, 548 cases in control group started following after cervical biopsy under the colposcope. The following intermissions were 6 months, 12 months,24 months,36 months,Liquid-based cytological test （LCT） and hybrid captured-Ⅱ for high rate humanpapilomavirus （HR HPV） test were used in every following test, and if the LCT result was atypical squamous cells （ASC-US） and HR-HPV positive, or the LCT result was greater than or equal, cervical biopsy was undergone by the colposcope to make sure the CIN Ⅰ diagnosis. Results （1） The lost rates of treatment group and control group in 36 months were 18.66% and 10. 22%. （2） The inversion rates in 6 months,12 months,24 months and 36 months were 77.51%,80. 38%,86.12% and 88.28%,inversion cases were rose up by the treatment gradually, succession rates were 33.01%, 22.97%, 9.33 % and 1.44 % , and descended down gradually. （3） The inversion rates in treatment group and control group increased with observation time, there were significant differences during the 6 months, 12 months, 24 months and 36 months （ P 〈 O. 05）; the succession rates in treatment group and control group descended with observation time, there were significant differences during the 6 months, 12 months and 24 months （P 〈O. 05）, and there were not significant differences in the 36 months, but significant differences between treatment group＇s and control group＇s progressive rate. Conclusions No solid scar, improving lesions inversion, reducing succession rate, guarding against the canceration were the advantages of HIFU in treatment for CIN Ⅰ.