阴道内镜检查术在绝经后宫颈鳞状上皮内病变中的应用

Vaginal endoscopy in postmenopausal cervical squamous intraepithelial lesions

目的 探讨阴道内镜检查术联合球囊牵引法改良宫颈冷刀锥切术在绝经后萎缩宫颈鳞状上皮内病变中的应用。方法 选取三门峡市中医院2019年1月至2023年4月收治的绝经后萎缩宫颈鳞状上皮内病变患者80例,根据患者意愿将纳入患者分为对照组(30例)和观察组(50例)。入院确诊后,对照组采用宫颈冷刀锥切术,观察组采用阴道内镜检查术联合球囊牵引法改良宫颈冷刀锥切术。观察比较两组手术相关指标、术后病理情况以及术后阴道出血率、病灶切除范围,记录术后6、12个月高危型人乳头瘤病毒(HPV)阳性率。结果 观察组手术时间[(45.27±3.02)min]长于对照组[(32.35±3.25)min],手术费用高于对照组,差异有显著统计学意义(P<0.01),但两组术中出血量、术后出血量和住院时间无统计学差异(P>0.05)。术后,观察组病灶残留率、切缘阳性率、复发率均显著低于对照组(P<0.05或P<0.01),术中观察组宫颈切除组织锥高显著优于对照组(P<0.05或P<0.01)。术后6个月和术后12个月,观察组高危型HPV阳性率均显著低于对照组(P<0.01)。结论 用阴道内镜检查术联合改良宫颈冷刀锥切术治疗绝经后萎缩宫颈鳞状上皮内病变虽然增加了手术时间和费用,但可降低术后病灶残留率、切缘阳性率、复发率,增加术中切除宫颈组织锥体高度,降低术后6个月和12个月HPV感染率,值得临床推广。

Objective To investigate the application of vaginal endoscopy combined with modified cold knife conization of the cervix by balloon traction in postmenopausal atrophic cervical squamous intraepithelial lesions.Methods Totally eighty cases with postmenopausal atrophic cervical squamous intraepithelial lesions admitted to our hospital from January 2019 to April 2023 were selected,and the included patients were divided into a control group(30 cases)and an observa-tion group(50 cases)according to the patients'wishes.After admission,the control group was treated with cold knife conization of the cervix and the observation group was treated with modified cold knife conization of the cervix by vaginal endoscopy combined with balloon traction.The two groups were compared in terms of surgical parameters,post-operative pathology,post-operative vaginal bleeding rate,extent of lesion removal,and the rate of high-risk human papillomavir-us(HPV)positivity at 6 and 12 months after surgery.Results The operative time in the observation group[(45.27±3.02)min]was slightly longer than that in the control group[(32.35±3.25)min],and the operative cost was higher than that in the control group,with a statistically significant difference(P<0.01),but there was no statistical difference in the amount of intraoperative bleeding,postoperative bleeding and hospital stay between the two groups(P>0.05).Postopera-tively,the residual rate of lesions,positive incision margin rate and recurrence rate were significantly lower in the observa-tion group than in the control group(P<0.05 or P<0.01),and the intraoperative cone height of cervical excised tissue was significantly better in the observation group than in the control group(P<0.05 or P<0.01).At 6 months and 12 months after surgery,the positive rate of high-risk HPV in the observation group was significantly lower than that in the sions with vaginal endoscopy combined with modified cervical cold knife conization increases the operative time and cost,it reduces the postoperative lesion residual rate,positive margin rate and recurrence rate,increases the height of intraoperative resected cervical tissue cone,and reduces the rate of HPV infection at 6 and 12 months postoperatively,which is worthy of clinical promotion.