腹腔镜下全子宫切除手术治疗高级别宫颈上皮内瘤变的疗效及预后观察

Curative effect and prognosis of laparoscopic total hysterectomy in the treatment of high-grade cervical intraepithelial neoplasia.

目的观察腹腔镜下全子宫切除手术治疗高级别宫颈上皮内瘤变(CINⅢ级)的疗效及预后情况。方法回顾性选取2018年4月至2020年4月安徽医科大学第一附属医院收治的CINⅢ级患者65例,依据手术方式不同将其分为观察组(n=32)、对照组(n=33)。观察组行腹腔镜下全子宫切除术,对照组行宫颈冷刀锥切术。比较两组患者术前与术后24 h内凝血功能[凝血酶原时间(PT)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)]、炎症因子水平[D-二聚体(D-D)、C反应蛋白(CRP)],记录两组随访所得术后人乳头瘤病毒(HPV)感染结果、液基细胞学(TCT)结果、复发情况。结果术后24 h,两组PT、APTT较术前缩短,FIB较术前增加,观察组FIB为(3.86±0.39)g/L,高于对照组[(3.57±0.38)g/L],差异有统计学意义(P<0.05);两组PT、APTT比较,差异均无统计学意义(P>0.05)。术后24 h,两组D-D、CRP水平均较术前增加,观察组D-D、CRP为(6.01±0.65)、(15.17±1.53)mg/L,高于对照组[(4.92±0.53)(14.28±1.46)mg/L],差异均有统计学意义(P<0.05)。观察组术后3个月HPV感染率(12.50%)低于对照组(39.39%),差异有统计学意义(P<0.05),两组术后6、12个月HPV感染率比较,差异均无统计学意义(P>0.05);两组术后3、6、12个月TCT检查结果比较,差异无统计学意义(P>0.05);两组术后12个月复发率比较,差异无统计学意义(P>0.05)。结论对CINⅢ患者,经腹腔镜下全子宫切除术与宫颈冷刀锥切术均有效,前者近期有发生血栓倾向,后者适于有生育要求的年轻女性,但有一定复发率,需予以密切随访。

Objective To observe the curative effect and prognosis of laparoscopic total hysterectomy in the treatment of high-grade cervical intraepithelial neoplasia(CINⅢ).Methods From April 2018 to April 2020,65 patients with CINⅢin First Affiliated Hospital of Anhui Medical University were divided into observation group(n=32)and control group(n=33)according to the operation method.The observation group was given laparoscopic total hysterectomy,and the control group was given cold knife conization of the cervix.Blood coagulation function[prothrombin time(PT),fibrinogen(FIB),activated partial thromboplastin time(APTT)]and levels of inflammatory factors[D-dimer(D-D),C-reactive protein(CRP)]before operation and in 24 h after operation were compared between the two groups.Postoperative human papillomavirus(HPV)infection,liquid-based cytology(TCT)results,and recurrence during the follow-up were recorded.Results PT and APTT were shortened,and FIB was increased in the two groups in 24 h after operation.The FIB in the observation group was(3.86±0.39)g/L,which was higher than that in the control group[(3.57±0.38)g/L],the difference was statistically significant(P<0.05);there was no statistically significant difference between the two groups of PT and APTT(P>0.05).At 24 h after surgery,the levels of D-D and CRP in the two groups increased compared with those before the operation.The D-D and CRP levels in the observation group were(6.01±0.65)and(15.17±1.53)mg/L,which were higher than those in the control group[(4.92±0.53),(14.28±1.46)mg/L],the differences were statistically significant(P<0.05).The HPV infection rate in the observation group(12.50%)in 3 months after operation was lower than that in the control group(39.39%),the difference was statistically significant(P<0.05).There was no significant difference in HPV infection rate between the two groups in 6 months and 12 months after operation(P>0.05),and there were no significant differences in TCT results between the two groups in 3 months,6 months,and 12 months after operation(P>0.05).The recurrence rates in the two groups in 12 months after operation were 0 and 6.06%,respectively,the difference was not statistically significant(P>0.05).Conclusion Both laparoscopic total hysterectomy and cervical cold knife conization are effective in the treatment of patients with CINⅢ.Patients undergoing the former have a risk of thrombosis in short term,and the latter is suitable for young women with fertility requirements,but there is a certain probability of recurrence.Therefore,close follow-up is required.