子宫颈高级别上皮内瘤变行高频电刀宫颈锥切术临床价值

The clinical value of high frequency electrotome conization in the treatment of high-grade cervical intraepithelial neoplasia

目的:探讨高频电刀宫颈锥切术用于治疗子宫颈高级别上皮内瘤变的临床效果。方法:选择子宫颈高级别上皮内瘤变214例,接受高频电刀宫颈锥切术者172例作为观察组,接受宫颈环形电切术(LEEP术)者42例作为对照组。观察2组术中出血情况、术后出血情况、手术时间、术后感染率、术后宫颈管粘连率、切缘阳性率及复发率。结果:观察组手术时间(21. 02±1. 81) min,与对照组手术时间(21. 57±1. 48) min差异无统计学意义(P> 0. 05),术中出血量(13. 61±2. 39) m L高于对照组术中出血量(12. 60±2. 08) m L(P <0. 05)。观察组切缘阳性率和复发率分别为1. 74%和1. 59%,均低于对照组切缘阳性率9. 52%和复发率10. 81%(P <0. 05)。2组术后感染率、术后宫颈管粘连发生率差异均无统计学意义(P> 0. 05)。结论:高频电刀宫颈锥切术手术操作便捷,易于掌握,手术时间及术后并发症较LEEP术无明显提高,切缘阳性率及复发率优于LEEP术,为增加清除病灶率、减少复发,高频电刀可作为优先考虑的治疗方案。

Objective： To evaluate the clinical value of high frequency electrotome conization in the treatment of high-grade cervical intraepithelial neoplasia. Methods： One hundred and seventy-two HSIL patients treated with high frequency electrotome conization and42 HSIL patients treated with cervical loop electrosurgical excision procedure（ LEEP） were divided into the observation group and control group,respectively. The intraoperative hemorrhage,postoperative hemorrhage,operation time,postoperative infection rate,postoperative cervical canal adhesion rate,positive incisal margin rate and recurrence rate in two groups were observed. Results： The difference of the operation time between the observation group[（ 21. 02 ± 1. 81） min] and control group[（ 21. 57 ± 1. 48） min] was not statistically significant（ P〉0. 05）. The intraoperative blood loss in observation group[（ 13. 61 ± 2. 39） m L] was higher than that in control group[（ 12. 60 ± 2. 08） m L]（ P〈0. 05）. The positive incisal margin rate and recurrence rate in observation group（ 1. 74% and1. 59%） were lower than those in control group（ 9. 52% and 10. 81%）,respectively（ P〈0. 05）. The differences of the postoperative infection rate and postoperative cervical canal adhesion rate between two groups were not statistically significant（ P〉0. 05）.Conclusions： High frequency electrotome conization is easy to operate,and the peroperative bleeding,operation time and postoperative complication of which do not obviously improve compared with LEEP. The positive incisal margin rate and recurrence rate of high frequency electrotome conization are better than those of LEEP,and the high frequency electrotome conization can be the prior method in the treatment of cervical intraepithelial neoplasia.