针对不同CIN的4种LEEP术式及远期随访

Four types of LEEP for CIN of various areas: a retrospective cohort study

目的探讨对不同面积宫颈上皮内瘤变（CIN）的4种宫颈电环切术式（LEEP）。方法对2006年2月至2011年10月收治的经多点活检病理学诊断的446例CIN患者采取LEEP治疗。治疗分4种术式：针对病变面积≥2/3者行LEEP-A术式,切除2/3以上宫颈组织,109例;对病变面积〈2/3且≥1/3者行LEEP-B术式,切除1/3~2/3宫颈组织,203例;对病变面积〈1/3者行LEEP-C术式,切除1/3以下的宫颈组织,90例;对CIN位于外口和宫颈管内者行LEEP-D术式,削管式切除,44例。切除组织再次送检,观察切缘病理、切除组织体积、术中出血、愈合时间、并发症及对妊娠率的影响。随访（36.5±5.5）个月。结果 446例CIN包括Ⅰ级108例,Ⅱ级232例,Ⅲ级106例（非原位癌）：（1）术前活检与LEEP术后病理符合率为87.4%（390/446）。（2）4种LEEP术式切缘处病理学均阴性。（3）治愈率,LEEP-A、LEEP-B、LEEP-C、LEEP-D术式分别为99.1%（108/109）、98.5%（200/203）、100.0%（90/90）、93.2%（41/44）（P〉0.05）。（4）4种术式切除组织体积、术中出血和愈合时间均差异有统计学意义（P均〈0.05）。（5）LEEP-A术式的术后2年妊娠率显著低于LEEP-C术式和LEEP-D术式（P〈0.05）。结论依据CIN病变面积分别采用4种LEEP术式能够治愈CIN。

Objective To compare the effectiveness and safety of loop electrosurgical excision procedures （LEEP） with four different excision volumes and depths in treating CIN of different areas. Methods We retrospectively reviewed 446 cases of CIN diagnosed by colposcope-directed punch biopsies and treated with different types of LEEP at Jinan Military General Hospital from Feb. 2006 to Oct. 2011. Four categories of procedures are described below： LEEP-A for lesions ≥ 2/3 of cervical area： conization of ≥ 2/3 of cervical tissue （ 109 cases）. LEEP-B for lesions ≥ 1/3 but 〈 2/3 of cervical area： eonization of 1/3- 〈2/3 of cervical tissue （203 cases）. LEEP-C for lesions 〈 1/3 cervical area： conization of 〈 1/3 of cervical tissue （90 cases ）. LEEP-D for lesions limited to cervical opening and endocervieal canal： endocervical canal resection （44 cases）. Margin status and volume of LEEP specimens, bleeding volume, recovery time, complications, cure rate and fertility after LEEP were analyzed. The average follow-up duration was（ 36.5 ± 5.5） months. Results The 446 cases in this study included 108 of CIN I, 232 of CIN I1 , and 106 of CIN IU （not carcinoma in situ） patients. The accordance rate between punch biopsies before LEEP and excisional biopsies was 87.4% （390/446）. No positive margin was found in any LEEP specimens. The cure rates for LEEP-A, LEEP-B, LEEP-C and LEEP-D were 99.1% （108/109） , 98.5% （200/203）, 100.0% （90/90） and 93.2% （41/44）, respectively. The difference in cure rate was not statistically significant （P 〉 0. 05）. There were significant differences in specimen volume, bleeding volume, and recovery time among the four LEEP categories （ P 〈 0.05 ）. The pregnancy rate at 2 years after LEEP was significantly lower in group LEEP-A compared to group LEEP-C and LEEP-D （P 〈 0.05 ）. Conclusions Four Types of LEEP are highly effective in the treatment of CIN when appropriately applied according to the size and distribution of cervical lesions.