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

Efficacy and Prognosis of Laparoscopic Total Hysterectomy for High-grade Cervical Intraepithelial Neoplasia

目的探讨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。方法本研究选取2018年1月—2020年12月徐州市铜山区人民医院62例高级别宫颈上皮内瘤变患者,以随机数表法分组,常规组开展宫颈冷刀锥切术(31例),研究组采取腹腔镜下全子宫切除术(31例)。比较两组术后凝血功能、炎症因子,术后3个月及6个月复查的人乳头瘤病毒(human papilloma virus,HPV)感染情况、液基细胞学(thinprep cytologic test,TCT)复查结果。结果研究组患者术后24 h的FIB水平(3.93±0.40)g/L高于常规组的(3.44±0.42)g/L,差异有统计学意义(t=4.704,P<0.05);研究组患者术后24 h血清SAA水平(343.24±44.18)mg/L及CRP水平(16.14±2.08)mg/L均高于常规组的(268.67±43.62)、(13.62±1.91)mg/L,差异有统计学意义(t=6.687、4.969,P<0.05);研究组患者术后3个月HPV复查感染发生率为9.68%,明显低于常规组的35.48%,差异有统计学意义(χ^(2)=5.905,P<0.05);两组术后3、6个月的TCT检查结果及术后1年复发率比较,差异无统计学意义(P>0.05)。结论腹腔镜下全子宫切除术与宫颈冷刀锥切术治疗高级别宫颈上皮内瘤变患者均可取得较好的预后效果,腹腔镜下全子宫切除术可有效降低术后HPV感染情况,消除疾病的复发,但其存在损伤大、术后血栓形成风险高等弊端,而宫颈冷刀锥切术可保留患者生育能力,但会因为病变组织切除不完全等因素导致存在一定复发风险,因此,术式的选择需根据患者的意愿及病情进行综合考虑。

Objective To investigate the efficacy and prognosis of laparoscopic total hysterectomy for high-grade cervical intraepithelial neoplasia.Methods In this study,62 patients with high-grade cervical intraepithelial neoplasia in Xuzhou Tongshan District People's Hospital from January 2018 to December 2020 were selected and grouped by random number table method.The conventional group underwent cervical cold knife conization(31 cases)and the study group took laparoscopic total hysterectomy(31 cases).The postoperative coagulation function,inflammatory factors,human papillomavirus(HPV)infection at 3-month and 6-month postoperative reviews,and thinprep cytologic test(TCT)review results were compared between the two groups.Results The 24-h postoperative FIB level of patients in the study group(3.93±0.40)g/L was higher than that of the conventional group(3.44±0.42)g/L,and the difference was statistically significant(t=4.704,P<0.05);the 24-h postoperative serum SAA level(343.24±44.18)mg/L and CRP level(16.14±2.08)mg/L in the study group were higher than those in the conventional group(268.67±43.62)mg/L and(13.62±1.91)mg/L,and the differences were statistically significant(t=6.687,4.969,P<0.05);the incidence of HPV retest infection in patients in the study group at 3 months postoperatively was 9.68% significantly lower than that in the conventional group was 35.48%,and the difference was statistically significant(χ^(2)=5.905,P<0.05);the differences were not statistically significant when comparing the TCT findings at 3 months and 6 months after surgery and the recurrence rate at 1 year after surgery between the two groups(P>0.05).Conclusion Both laparoscopic total hysterectomy and cervical cold knife conization for the treatment of patients with highgrade cervical intraepithelial neoplasia can achieve better prognostic results.Laparoscopic total hysterectomy is effective in reducing postoperative HPV infection and eliminating recurrence of disease,but it has disadvantages such as high injury and risk of postoperative thrombosis.In contrast,cold knife hysterectomy can preserve the fertility of patients,but there is a certain risk of recurrence due to incomplete excision of diseased tissues,so the choice of the procedure should be considered according to the patient's wishes and condition.