低级别宫颈上皮内瘤变LEEP锥切术与期待治疗的效果观察

Efficacy of loop electrosurgical excision procedure conization and expectant management in patients with low- grade cervical intraepithelial neoplasia

目的:比较LEEP锥切术和药物期待治疗低级别宫颈上皮内瘤变的临床效果,分析病变进展危险因素,探讨CINⅠ的最佳治疗方式,防止病情进展。方法:选取160例CINⅠ患者随机分为观察组和对照组,观察组采用LEEP锥切术治疗,对照组采用药物期待治疗,比较两组病变转归及HR-HPV阳性转阴情况,分析病情进展危险因素。结果:观察组进展率为2.4%(2/82),持续率8.5%(7/82),逆转率89.1%(73/82);对照组进展率2.6%(2/78),持续率12.8%(10/78),逆转率84.6%(66/78),两组逆转率差异有统计学意义(P<0.05);观察组随访期间HR-HPV持续阳性38.0%(19/50),转阴率62.0%(31/50);对照组HR-HPV持续阳性30.2%(13/40),转阴69.8%(30/40),两组差异无统计学意义(P>0.05);持续HR-HPV阳性是CINⅠ病变转归独立危险因素。结论:采用期待治疗低级别宫颈上皮内瘤变安全有效,对于持续HR-HPV阳性患者应密切随访观察,防止病变进展。

Objectives： To compare the clinical effect of Loop electrosurgical excision procedure（ LEEP）conization and expectant management in patients with low- grade cervical intraepithelial neoplasia,to analyze the risk factors of disease progression and the best treatment for CINⅠ to prevent disease progression. Methods： The160 CINⅠ patients were randomly divided into observation group and control group. The observation group received the treatment of expectant management,and the control group was given the treatment of LEEP conization. The prognosis of HR- HPV positive and negative cases of two groups was compared and the risk factors for disease progression were analysed. Results： The progress rate,sustained rate and reversal rate of observation group were2. 4%（ 2 /82）,8. 5%（ 7 /82）,89. 1%（ 73 /82）,and those in the control group were 2. 6%（ 2 /78）,12. 8%（ 10 /78）,84. 6%（ 66 /78） respectively. The reversal rate between the two groups was significantly different（ P〈0. 05）. The HR- HPV continued positive rate at follow- up period and negative rate of the control group were 38.0%（ 19 /50） and 2. 0%（ 31 /50）,without statistically significant difference between the two groups（ P〉0. 05）.The HR- HPV continued positive was an independent risk factor for the outcome of CINⅠ. Conclusion： The treatment of expectant management in patients with low- grade cervical intraepithelial neoplasia is effective. The HR-HPV continued positive patients should receive close follow- up to prevent the progression of the disease.