改良宫颈冷刀锥切术对高级别宫颈上皮内病变的疗效观察

Observation on the efficacy of modified cold knife conization for high-grade cervical intraepithelial lesions

目的 探索改良宫颈冷刀锥切术对高级别宫颈上皮内病变患者临床治疗效果、炎症反应及宫颈机能的影响。方法 选取保定市第二中心医院2018年1月至2021年1月收治的80例高级别宫颈上皮内病变患者的临床资料,按照手术方法将其分为改良组和传统组,其中改良组49例,给予改良宫颈冷刀锥切术治疗,传统组31例,给予传统宫颈冷刀锥切术治疗。对比两组患者治疗效果及手术前后炎症反应、宫颈机能变化、术后并发症发生率、标本切缘病理结果阳性率。结果 改良组手术时间、切口愈合时间均短于传统组,术中出血量少于传统组(P<0.05);与手术前1 d比较,术后14 d两组患者白细胞介素-6(IL-6)、白细胞介素-7(IL-7)、细胞毒性T细胞(CD8^(+))水平均降低,且改良组低于传统组,辅助性T细胞(CD4^(+))、CD4^(+)/CD8^(+)水平均升高,且改良组高于传统组(P<0.05);与手术前1 d比较,术后3个月两组患者宫颈长度均缩短,且改良组缩短程度低于传统组,宫颈管宽度均增加,改良组增加程度低于传统组(P<0.05);改良组并发症发生率与宫颈机能不全发生率均低于传统组(P<0.05)。结论 改良宫颈冷刀锥切术治疗高级别宫颈上皮内病变可减少患者术中出血量,缩短手术时间,加快康复进程,减轻炎症反应,改善免疫功能,对宫颈机能影响较小,安全有效。

Objective To explore the effect of different cold knife surgery methods on the clinical treatment effect,inflammatory response and cervical function in patients with high-grade cervical intraepithelial lesions.Methods The clinical data of 80 patients with high-grade cervical intraepithelial lesions admitted to the hospital from January 2018 to January 2021 were selected,and the patients were divided into modified and traditional groups according to the surgical method,in which 49 patients in the modified group were treated with modified cervical cold knife conization,and 31 patients in the traditional group were treated with traditional cervical cold knife conization.The treatment results,inflammatory response,changes in cervical function,postoperative complication rate and positive pathology rate of specimen margin were compared between the two groups.Results The operation time and incision healing time of the modified group was shorter than those of the traditional group,and the intraoperative blood loss was lower than that of the traditional group(P<0.05).Compared with 1 d before the surgery,the levels of interleukin-6(IL-6),interleukin-7(IL-7)and cytotoxic T cells(CD8^(+))were reduced in the two groups 14 days after the surgery,and the modified group was lowerr than that in the traditional group;and the levels of helper T cells(CD4^(+))and CD4^(+)/CD8^(+)were higher in the modified group than in the traditional group.Compared with 1 days before the surgery,the cervical length of both groups was shortened 3 months after the surgery,and the shortening degree of the modified group was lower than that of the traditional group,and the width of the cervical canal was increased,and the increase of the modified group was lower than that of the traditional group(P<0.05).The incidence of complications and cervical insufficiency in the modified group was lower than that in the traditional group(P<0.05).Conclusion Modified cervical cold-knife conization in the treatment of the patients with high-grade cervical intraepithelial lesions can reduce the amount[JP^(+)4]of intraoperative blood loss,shorten the operation time,speed up the recovery process,reduce the inflammatory response,and improve the immune function,less impact on cervical function,it is safe and effective.