LEEP和CKC治疗高级别宫颈上皮内瘤变的疗效及对妊娠结局的影响

Efficacy comparison of LEEP and CKC in the treatment of high-grade cervical intraepithelial neoplasms and their effect on pregnancy outcome

目的探讨宫颈环形电圈电切术(LEEP)与宫颈冷刀锥切术(CKC)治疗高级别宫颈上皮内瘤变的疗效及对妊娠结局的影响。方法回顾性分析128例宫颈高级别上皮内瘤变患者临床资料,其中接受LEEP治疗76例,接受CKC治疗52例,比较两组的临床疗效及随访妊娠结局。结果LEEP组术中出血量、手术时间及术后感染率均明显低于CKC组(t分别=6.13、7.24,χ^2=6.49,P均<0.05);LEEP组术后宫颈狭窄发生率、切缘阳性率及术后24个月复发率与CKC组比较,差异均无统计学意义(χ^2分别=0.21、0.23、0.04,P均>0.05)。两组患者妊娠、异位妊娠、流产、早产、足月产、自然分娩、剖宫产率及低体重出生儿的发生率比较,差异均无统计学意义(χ^2分别=0.05、0.86、0.23、0.11、0.02、0.39、0.24、1.67,P均>0.05)。结论LEEP与CKC均为治疗高级别上皮内瘤变的安全且有效的手段,两种术式对妊娠结局的影响无明显区别,但LEEP具有手术时间短、术中出血量少、术后感染率低等方面优势。

Objective To investigate the efficacy of LEEP and CKC in the treatment of high-grade cervical intraepithelial neoplasia and the influence of pregnancy outcome.Methods The clinical data of 128 patients with cervical high-grade intraepithelial neoplasia were retrospectively analyzed.76 patients received LEEP and 52 patients received CKC.The clinical efficacy and pregnancy outcome of the two groups were compared.Results The bleeding volume in operation,operation time and infection rate in LEEP group were significantly lower than those in CKC group(t=6.13,7.24,χ^2=6.49,P<0.05),and there were no significant difference in the incidence of cervical stenosis,the positive rate of incision margin and the recurrence rate in 24 months after operation between LEEP group and CKC group(χ^2=0.21,0.23,0.04,P>0.05).There was no significant differences in pregnancy,ectopic pregnancy,abortion,premature delivery,full-term delivery,natural delivery,cesarean section rate and the incidence of low birth weight infants between the two groups(χ^2=0.05,0.86,0.23,0.11,0.02,0.39,0.24,1.67,P>0.05).Conclusion Both LEEP and CKC are safe and effective methods for the treatment of high-grade intraepithelial neoplasia.There is no significant difference in the effect of the two surgical methods on pregnancy outcomes,but LEEP has obvious advantages in shorter operation time,less intraoperative bleeding and lower infection rate after operation.