宫颈上皮内瘤变Ⅱ级的非手术干预效果评价

Effect of non-operative treatment on cervical intraepithelial neoplasia Ⅱ

目的探讨宫颈上皮内瘤变Ⅱ级(cervical intraepithelial neoplasia,CINⅡ级)的非手术治疗干预效果。方法回顾性分析137例阴道镜下宫颈组织活检病理分型为CINⅡ级患者的临床资料,按治疗方法分为手术治疗组(77例)和保守治疗组(60例),保守治疗组患者高危HPV-DNA检测阳性者单纯行抗病毒治疗,随访观察两组患者的疾病转归及预后。结果患者中位随访时间为20个月。手术治疗组患者术后随访未见异常者68例,5例仍为CINⅡ级,4例进展为CINⅢ级;保守治疗组患者随访未见异常者43例,10例病变仍持续,7例进展为CINⅢ级,2组治愈率无显著差异(P>0.05)。手术治疗组术后随访高危型HPV-DNA转阴率显著高于保守治疗组(P<0.01)。结论CINⅡ级患者单纯进行抗病毒干预治疗并定期随诊,具有较高的自然消退率,但高危型HPV-DNA转阴率显著低于手术治疗组,如何进一步规范CINⅡ级处理方式,还有待于进一步的研究。

Objective To evaluate the effect of non-operative treatment of cervical intraepithelial neoplasia Ⅱ（ CIN gradeⅡ）. Method The clinical data of 137 vaginoscopic cases were firstly reviewed and analyzed. The 137 selected samples were defined as CIN grade Ⅱ and were divided into a surgerical group（ n = 77） and a conservative care group（ 60 cases）.Patients in the conservative care group carrying high-risk HPV were given antiviral treatment. The disease outcome of the two groups were followed. Findings The medium follow-up time was 20 months. 68 cases in the surgerical group did not show abnormality. 5 cases remained to be CIN grade Ⅱ and 4 cases progressed into CIN grade Ⅲ. In the conservative care group,43 cases did not show abnormality. 10 cases remained to be CIN grade Ⅱ and 7 cases progressed into CIN gradeⅢ. There was no significant difference in the cure rate between the two groups（ P〉0. 05）. The detection of high-risk HPV DNA to negative outcome in the surgerical group during follow-up period was significantly higher than that of the conservative care group（ P〈0. 01）. Conclusion Patients diagnosed as CIN grade Ⅱ having antiviral treatment and regular medical exam had high regression rate while the high-risk HPV-DNA to negative appearance was significantly lower than that of the operative group. A more standardized treatment for CIN grade Ⅱ needs to be developed.