宫腔镜辅助冷刀锥形切除术治疗Ⅱ、Ⅲ级宫颈上皮内瘤变疗效观察

Clinical effect of hysteroscopic assisted cold knife conization in treating grade Ⅱ and Ⅲ of cervical intraepithelial neoplasia

目的探讨宫腔镜辅助冷刀锥形切除术治疗Ⅱ、Ⅲ级宫颈上皮内瘤变(CIN)的临床效果。方法将2015年7月至2016年9月许昌市中医院收治的经组织活检确诊为Ⅱ、Ⅲ级CIN的118例患者分为对照组(n=62)和观察组(n=56)。对照组患者给予宫腔镜宫颈锥形切除术,观察组患者给予宫腔镜辅助冷刀锥形切除术。比较2组患者的手术时间、术中出血量、住院时间及术后6个月液基薄层细胞检测异常率、高危人乳头瘤病毒清除率、CIN复发率,并观察2组患者术后并发症发生情况。结果所有患者成功实施手术,无术中转行其他手术者,手术成功率100. 0%。观察组患者术中出血量显著高于对照组(t=6. 322,P <0. 05),2组患者的手术时间及住院时间比较差异无统计学意义(t=0. 753、0. 315,P> 0. 05)。术后6个月,对照组患者液基薄层细胞检测异常率、CIN复发率、高危人乳头瘤病毒清除率分别为12. 9%(8/62)、6. 5%(4/62)和95. 2%(59/62),观察组患者液基薄层细胞检测异常率、CIN复发率、高危人乳头瘤病毒清除率分别为8. 9(5/56)、1. 8(1/56)和98. 2%(55/56),2组患者液基薄层细胞检测异常率、CIN复发率、高危人乳头瘤病毒清除率比较差异无统计学意义(χ~2=0. 471、0. 642、0. 160,P> 0. 05)。对照组患者术后宫颈粘连发生率及月经异常率分别为14. 5%(9/62)、14. 5%(9/62),观察组患者术后宫颈粘连发生率及月经异常率分别为1. 8%(1/56)、1. 8%(1/56),观察组患者术后宫颈粘连发生率及月经异常率显著低于对照组(χ~2=4. 623、4. 623,P <0. 05)。结论宫腔镜辅助冷刀锥切术治疗Ⅱ、Ⅲ级CIN安全有效,术后宫颈粘连发生率及月经异常率低。

Objective To evaluate the clinical effect of hysteroscopic assisted cold knife conization in the treating grade Ⅱ and Ⅲ of cervical intraepithelial neoplasia （CIN）.Methods One hundred and eighteen patients with grade Ⅱ and Ⅲ of CIN diagnosed by biopsy and pathology in Traditional Chinese Medicine Hospital of Xuchang City from July 2015 to September 2016 were selected and divided into control group（ n =62） and observation group（ n =56）.The patients in the control group were given hysteroscopic cervical conization and the patients in the observation group were given hysteroscope assisted cold knife conization.The operative time,intraoperative blood loss,hospital stay and abnormal rate of thin-cytologic test,high-risk human papillomavirus clearance rate,CIN recurrence rate at six months after operation were compared between the two groups.The postoperative complications were also observed and compared between the two groups.Results All patients were successfully operated,with a success rate of 100.0%.The amount of bleeding during operation in the observation group was significantly higher than that in the control group （ t =6.322, P 〈0.05）.There was no statistically significant difference in the operation time and hospitalization time（ t =0.753,0.315; P 〉0.05）.Six months after operation,the abnormal rate of liquid based thin layer cells,CIN recurrence rate and high-risk human papillomavirus clearance rate in the control group was 12.9%（8/62）,6.5%（4/62）,95.2%（59/62）,respectively.While it was 8.9（5/56）,1.8（1/56）,98.2%（55/56） respectively in the observation group.There was no statistically significant difference in the abnormal rate of thin-cytologic test,CIN recurrence rate and high-risk human papillomavirus clearance rate between the two groups （ χ 2=0.471,0.642,0.160; P 〉0.05）.The incidence of cervical adhesions and abnormal rate of menstruation in the control group was 14.5%（9/62） and 14.5%（9/62）,while it was 1.8%（1/56） and 1.8%（1/56）in the observation group.The incidence of cervical adhesions and abnormal rate of menstruation in the observation group was lower than that in the control group（ χ 2=4.623,4.623; P 〈0.05）.Conclusions Hysteroscopic assisted cold knife conization in the treatment of grade Ⅱ and Ⅲ CIN is safe and effective.The incidence of cervical adhesions and menstrual abnormality decreased significantly.