环形电外科切除术治疗宫颈上皮内瘤变伴高危型人乳头瘤病毒感染的临床研究

Clinical study on loop electrosurgical excision procedure in the treatment of cervical intraepithelial neoplasia with high-risk human papilloma virus( HR-HPV) infection

目的 探讨环形电外科切除术（loop electrosurgical excision procedure,LEEP）在宫颈上皮内瘤变（CIN）伴高危型人乳头瘤病毒（HPV）感染患者中的应用效果.方法 采用LEEP治疗98例CIN伴HR-HPV感染患者,手术前后均行HR-HPV检测,观察手术效果及HR-HPV变化.结果 所有患者均顺利完成手术,术后随访1年,治愈率为90.8%（89/98）,复发率为9.2%（9/98）;其中CINⅠ患者治愈率为100%（64/64）,显著高于CINⅡ～Ⅲ患者的73.5%（25/34）（P＜0.01）,CINⅠ患者复发率显著低于CINⅡ～Ⅲ患者（P＜0.01）.术后6个月HR-HPV阳性率为31.6%（31/98）,显著低于治疗前（P＜0.01）,转阴率为68.4%（67/98）;术后1年HR-HPV阳性率再次显著下降为15.3%（15/98）（P＜0.01）,转阴率为84.7%（83/98）（P＜0.01）.结论 LEEP治疗CIN疗效显著,且可消除大部分HR-HPV感染,降低CIN复发率及宫颈癌发生率,操作简便,并发症较少,值得推广.

Objective To study the clinical effects of loop electrosurgical excision procedure （LEEP） in cervical intraepithelial neoplasia （CIN） patients with high-risk human papilloma virus （HR-HPV） infection. Methods Ninety-eight CIN patients with HR-HPV infection were treated with LEEP. All patients were performed with HR-HPV test both before and after LEEP. Clinical effects of the patients were assessed. Results All patients were successfully operated. The cure rate was 90.8% （89/98）, and the recurrence rate was 9.2% （9/98） after 1-year follow-up. The cure rate in patients with CIN Ⅰ was 100% （64/64）, significantly higher than 73.5% （25/34） in patients with CINⅡ-Ⅲ（P＜0.01）, and the recurrence rate of patients with CIN Ⅰ was significantly lower than that of patients with CINⅡ-Ⅲ（0% versus 26.5%,P＜0.01）. Positive rate of HR-HPV was 31.6% （31/98） 6 months after the treatment, significantly lower than that before LEEP（P＜0.01）, and negative conversion rate was 68.4% （67/98）;and 1 year later, they continued to decrease to 15.3% （15/98） and 84.7% （83/98）, respectively, all with statistical significance （P＜0.01）. Conclusion LEEP is effective in the treatment of CIN, also it can eliminate most of the HR-HPV infections, thus reduce the recurrence rate of CIN and incidence of cervical cancer. In addition, it′s easy to operate, with fewer complications, and worthy of promotion.