Hysteroscopic cervical biopsy for women with persistent human papillomavirus infection after loop electrosurgical excision procedure: A case report

BACKGROUNDAlmost all cases of cervical cancer can be attributed to human papillomavirus(HPV) infection. The loop electrosurgical excision procedure (LEEP) is widelyused to treat HPV-mediated disease;thus, cervical cancer is highly preventable.However, LEEP does not necessarily clear HPV rapidly and may affect theaccuracy of the results of ThinPrep cytology test (TCT) and cervical biopsy due tothe formation of cervical scars.CASE SUMMARYA 40-year-old woman underwent LEEP for cervical intraepithelial neoplasia grade1 approximately 10 years ago. Subsequent standard cervical cancer screeningsuggested persistent HPV-52 infection, but TCT results were negative. Cervicalbiopsy under colposcopy was performed thrice over a 10-year period, yieldingnegative pathology results. She developed abnormal vaginal bleeding after sexualactivity, persisting for approximately 1 year, and underwent hysteroscopy in ourhospital. Histopathologic evaluation confirmed adenocarcinoma in situ of theuterine cervix.CONCLUSIONPatients with long-term persistent, high-risk HPV infection and negative pathologyresults of cervical biopsy after LEEP are at risk of cervical cancer. Hysteroscopicresection of cervical canal tissue is recommended as a supplement tocervical biopsy because it helps define the lesion site and may yield a pathologicdiagnosis.

Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation and Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Treatment: A Pilot Study among Zambian Women

Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for Cervical Intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times higher odds of adverse pregnancy outcomes respectively, relative to women who required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical Intraepithelial Neoplasia has been linked to higher chances of experiencing abortion, delivering low birth weight babies and enduring prolonged labor that may result in a caesarean section delivery. Cervical neoplasia treatments, particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in obstetric care.

Same day colposcopic examination and loop electrosurgical excision procedure (LEEP) presents minimal overtreatment and averts delay in treatment of cervical intraepithelial neoplasia in Kenyatta National Hospital, Kenya

Background: Screening for cancer of the cervix at Kenyatta National Hospital (KNH), follows the recommended three-step strategy;Papanicolaou (Pap) smear, colposcopy/biopsy and loop electrosurgical excision procedure (LEEP)/biopsy. This approach poses the following challenges: multiple clinic visits, costly, time consuming, long turnaround time to treatment, non-compliance and loss-to-follow-up. Objective: To determine the agreement between histologies following colposcopy and LEEP amongst women in KNH as a forerunner for opportunity to shift from the three-step approach to the two-step “see and treat” (same-day colposcopy and LEEP) approach. Methods: This was a retrospective descriptive cohort of Women who underwent LEEP procedure between January 2008 and 31st December 2010 following the three-step approach at KNH, Kenya. Results: A total of 124 patients out of the 132 patients who underwent LEEP were included in the analysis. The 8 patients excluded had missing files. HIV infected, uninfected or unknown women are similar socio-demographically. The mean (SD) age for the HIV infected, uninfected and unknown is 37 (6), 33 (10) and 35 (9) years respectively. Colposcopic and LEEP biopsy histology within patients demonstrated a high weighted kappa statistics agreement of 84%. LEEP increased diagnosis of invasive cancer. Patients had a median (IQR) 5 (4 - 6) clinic visits from Pap smear to LEEP treatment. It took median (IQR) 55 (27 - 116) days between Pap smear to colposcopy result and 167 (101 - 276) days between Pap smear results to LEEP treatment. If a LEEP procedure were to be performed in this cohort of women on the same day of the colposcopy biopsy a median (IQR) 77 (55 - 137) days could have been saved. Conclusion: There is a high agreement between colposcopy and LEEP biopsies in our setting offering a window of opportunity to perform “See and Treat” same-day colposcopy and LEEP treatment procedure, skipping the colposcopy biopsy stage.

CIN Ⅲ级患者阴道菌群生态平衡与LEEP术后复发关系探讨

目的:探讨宫颈上皮内瘤变(CIN)Ⅲ级患者阴道菌群生态平衡情况及其与宫颈环形电切术(LEEP)术后复发的关系。方法:回顾性收集本院2018年1月-2023年12月接受LEEP治疗的200例CIN Ⅲ级[高危型人乳头瘤病毒(HR-HPV)均为阳性]患者临床资料为观察组,体检健康女性50例为对照组,均接受阴道微生态检测,对比观察组手术前后、对照组体检时阴道微生态相关指标。依据LEEP术后2年复发与否将观察组分组,对比复发组与未复发组术后阴道微生态相关指标及其他临床资料,logistic回归分析LEEP术后复发的危险因素。结果:观察组术前阴道菌群密集度多样性Ⅱ~Ⅲ级、乳杆菌分级Ⅰ~Ⅱa级及过氧化氢(H_(2)O_(2))阳性比例均低于对照组,阴道pH值、白细胞酯酶(LE)/唾液酸苷酶(SNA)LE/SNA阳性比例均高于对照组;术后阴道菌群密集度/多样性Ⅱ~Ⅲ级、乳杆菌分级Ⅰ~Ⅱa级及H_(2)O_(2)阳性比例均较术前增大,阴道pH值、LE/SNA阳性比例均较术前减小(均P<0.05)。观察组LEEP术后2年复发率为10.0%,复发组术后阴道菌群密集度/多样性Ⅱ~Ⅲ级、乳杆菌分级Ⅰ~Ⅱa级及H2O2阳性比例均低于未复发组,阴道pH值、LE/SNA阳性、绝经、术前HPV多重感染、术前HR-HPV病毒载量≥100 RLU/CO、病变累及阴道壁、手术切缘阳性、术后HR-HPV持续感染比例均大于未复发组(均P<0.05);logistic回归分析,阴道菌群密集度Ⅱ~Ⅲ级、乳杆菌分级Ⅰ~Ⅱa级是术后2年复发的保护因子(P<0.05),高pH值、HR-HPV持续感染是危险因子(P<0.05)。结论:CINⅢ级患者术前阴道菌群生态多失衡,LEEP能有效改善患者阴道菌群生态,但术后仍有复发风险,且复发与LEEP术后阴道菌群密集度、乳杆菌分级、pH值、术后HR-HPV持续感染有关。

干扰素α-2b联合氯喹那多/普罗雌烯对宫颈上皮内瘤变Leep术后的疗效观察

目的探究人干扰素α-2b(INFα-2b)联合氯喹那多/普罗雌烯(CP)对宫颈上皮内瘤变(CIN)宫颈环形电切术(LEEP)术后的临床疗效。方法回顾性收集2022年9月至2023年9月北京市顺义区妇幼保健院妇科收治的CIN患者临床资料。根据LEEP术后用药方案不同分为干扰素组(INFα-2b)和联合组(INFα-2b联合CP)。比较治疗前和治疗后3个月炎症因子[C-反应蛋白(CRP)和淀粉样蛋白A(SAA)]和免疫功能因子[CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)]变化情况。评估治疗后临床疗效[治疗有效率、HPV转阴率和半年复发率]和并发症发生情况。结果共纳入106例CIN患者,其中干扰素组68例,联合组38例。治疗前,两组患者的血清CRP、SAA水平、血液CD4^(+)淋巴细胞比例、CD8^(+)淋巴细胞比例和CD4^(+)/CD8^(+)比值比较差异无统计学意义(P>0.05)。与治疗前相比,治疗后两组患者的血清CRP、SAA水平和血液CD8^(+)淋巴细胞比例显著下降,而血液CD4^(+)淋巴细胞比例和CD4^(+)/CD8^(+)比值显著上升。此外,治疗后联合组血清CRP、SAA水平和血液CD8^(+)淋巴细胞比例显著低于干扰素组(P<0.05),而血液CD4^(+)淋巴细胞比例和CD4^(+)/CD8^(+)比值显著高于干扰素组(P<0.05)。联合组治疗有效率和HR-HPV转阴率显著高于干扰素组(P<0.05)。但两组患者的半年复发率和术后并发症发生率差异无统计学意义(P>0.05)。结论INFα-2b联合CP可改善CIN患者LEEP术后炎症水平和免疫功能、提升临床疗效和HPV转阴率,但不影响半年复发率和并发症发生率。

改善阴道微生态对高级别子宫颈鳞状上皮内病变患者行宫颈环形电切术后宫颈管粘连的影响

目的探讨改善阴道微生态对高级别子宫颈鳞状上皮内病变(HSIL)患者行宫颈环形电切术(LEEP)后宫颈管粘连的影响。方法选取2021年11月至2023年1月衡水市人民医院收治的210例行LEEP的HSIL患者作为研究对象,根据随机数字表法分为对照组与试验组,每组105例。术后,对照组采用雌三醇软膏治疗,试验组采用雌三醇软膏联合乳杆菌活菌胶囊治疗,连续治疗10 d。比较两组术后宫颈粘连发生率、手术前后阴道微生态情况、阴道分泌物功能酶活性。结果试验组宫颈粘连发生率低于对照组,差异具有统计学意义(P<0.05)。术后2周,试验组pH 3.8~4.5、阴道菌群密度Ⅰ~Ⅱ级、阴道微生态正常率均高于对照组,差异具有统计学意义(P<0.05)。术后6周,试验组唾液酸酶(SNA)活性阳性率低于对照组,差异具有统计学意义(P<0.05);术后12周,试验组过氧化氢(H_(2)O_(2))、白细胞酯酶(LE)、SNA活性阳性率均低于对照组,差异具有统计学意义(P<0.05)。结论临床上给予LEEP术后HSIL患者乳杆菌治疗,可降低术后宫颈粘连发生率,改善阴道微生态,调节阴道分泌物功能酶活性。

The Importance of Endocervical Curettage in an Old Post-Loop Electrosurgical Excision Procedure Woman with Abnormal Cervical Cytology and a Normal Punch Biopsy Histology:A Case Report and Literature Review

Endocervical curettage(ECC)is an optional practice during colposcopy,and the indication for endocervical curettage(ECC)is controversial between Europe and the USA.Here,we explored the value of ECC in a specific situation.An elderly post-loop electrosurgical excision procedure woman,who had undergone a colposcopy 4 months before,went for her follow-up and abnormal cytology was found,and both the ECC and punch biopsy showed negative results.Then,a second ECC was performed,which led to the diagnosis of a high-grade squamous intraepithelial lesion.This case report shows that ECC is useful for diagnosing elderly women with Type 3 squamocolumnar junction.

Fertility and Sexual Function after Loop Electrosurgical Excision Procedure in Patients with High-Grade Squamous Intraepithelial Lesion

Objective:Loop electrosurgical excision procedure(LEEP)is the first choice for patients with high-grade squamous intraepithelial lesion(HSIL).This study aimed to investigate postoperative fertility and sexual function in patients with HSIL after LEEP.Methods:This cohort study included patients with HSIL enrolled at 11 obstetrics and gynecology hospitals between January 1,2013,and December 31,2015.The patients were treated with LEEP only.Ultimately,760 patients meet our inclusion and exclusion criteria.Our research included two parts:The effect of LEEP on postoperative fertility and the effect of LEEP on postoperative sexual function.In the two different parts of the research,we chose different case series according to their follow up information.Results:In the LEEP group,125 patients had successful deliveries and 27 were preterm(21.6%).The risk of preterm birth was significantly higher in the case group(relative risk[RR]:2.634;95%confidence interval[CI]:1.689-4.108).As the cone depth and volume increased,the risk of preterm increased.In this study,the raw relative risk of cesarean section(CS)was increased in the LEEP group,however the constituent ratio of the indications in the LEEP group was not significantly different from that of the control group.With increased cone depth and volume,pain during postoperative sexual intercourse gradually increased.Conclusions:LEEP increases the risk of preterm birth.The risk increases as the cone depth and volume increases.LEEP could lead to pain during sexual intercourse.

不同子宫颈锥切方案治疗高级别子宫颈上皮内瘤变的临床对比

目的:对比分析子宫颈环形电切术(LEEP)、普通电刀锥切术(EKC)在高级别子宫颈上皮内瘤变(CIN)患者中的应用效果。方法:本研究采用前瞻性随机对照的研究方法,选取2018年1月-2021年6月樟树市第三人民医院收治的84例高级别CIN患者,以随机数字表法将患者分为LEEP组(行LEEP治疗)与EKC组(行EKC治疗),每组42例。比较两组一般资料、手术时间、术中出血量、锥切高度及锥切面积、切缘状态;比较两组人乳头瘤病毒(HPV)感染、病灶残留、病灶复发及并发症发生情况。结果:两组手术时间、术中出血量比较,差异均无统计学意义(P>0.05)。LEEP组锥切面积小于EKC组,锥切高度低于EKC组,差异均有统计学意义(P<0.05)。LEEP组切缘阳性率高于EKC组,差异有统计学意义(P<0.05)。术前,两组HPV感染率比较,差异无统计学意义(P>0.05);术后6个月,两组HPV感染率均低于术前,差异有统计学意义(P<0.05);但两组术后6个月HBV感染率对比,差异无统计学意义(P>0.05)。两组病灶残留率对比,差异无统计学意义(P>0.05)。LEEP组病灶复发率高于EKC组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:LEEP、EKC治疗高级别CIN的手术时间、术中出血量相当,但EKC在维持切割深度、切除病灶、降低切缘阳性率方面更具优势,且LEEP、EKC治疗高级别CIN均具有较好的安全性。

宫颈环形电切术与冷刀锥切术治疗宫颈上皮内瘤变Ⅲ级患者的临床效果

目的探讨宫颈环形电切术(LEEP)与冷刀锥切术(CKC)治疗宫颈上皮内瘤变(CIN)Ⅲ级患者的临床效果。方法回顾性分析2020年1月至2022年1月于医院接受手术治疗的68例CINⅢ级患者的临床资料,根据手术方式不同分为对照组与试验组,每组34例。对照组采用CKC治疗,试验组采用LEEP治疗。比较两组治疗效果、手术指标、并发症及术后复发情况。结果两组治疗效果比较,差异无统计学意义(P>0.05);试验组手术时长、愈合时间及住院时间均短于对照组,出血量少于对照组,锥切组织面积小于对照组,差异均有统计学意义(P<0.05);试验组术后并发症发生率低于对照组,差异有统计学意义(P<0.05);两组术后复发率比较,差异无统计学意义(P>0.05)。结论CKC与LEEP治疗CINⅢ级患者的效果相当,但LEEP可有效减轻创伤,降低并发症发生风险,促进患者康复。

干扰素联合LEEP术方案对宫颈上皮内瘤变的治疗效果

目的探讨宫颈上皮内瘤变患者接受LEEP术和干扰素联合治疗的临床价值。方法在2019年6月至2022年6月实施本次前瞻性对照研究,纳入研究对象总数量为60例,经临床诊断为宫颈上皮内瘤变并积极接受治疗。予以随机抽签法分组,设定分组比例1∶1。对照组接受单一LEEP术治疗方案,观察组采取干扰素联合LEEP术方案治疗。比较两组治疗效果、相关临床指标时间、免疫功能指标、生活质量评分、临床并发症发生率以及HPV感染情况。结果在临床总有效率方面,观察组总有效率比对照组更高(90.00%vs.66.67%,χ^(2)=4.8118,P<0.05)。观察组阴道排液时间、创面愈合时间、阴道出血时间、腰骶酸痛消失时间均短于对照组,P<0.05。两组患者CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)水平比较,治疗后观察组各项水平均高于对照组,P<0.05。比较生活质量情况,经治疗,观察组社会关系、躯体疼痛、生理功能、活力评分均比对照组高,P<0.05。临床并发症比较,观察组较对照组略高,但组间数据差异无统计学意义,P>0.05。治疗后观察组HPV感染率明显较对照组更低,P<0.05。结论宫颈上皮内瘤变患者临床治疗时采取干扰素联合LEEP术方案所获得的效果较单一LEEP术治疗更好,可进一步提高患者免疫功能,缩短康复指标时间,提高HPV转阴率及生活质量,且未明显增加患者相关并发症的发生,有效性和安全性均获得保障。

重组人干扰素α-2b治疗宫颈高危HPV感染的价值分析

目的探讨重组人干扰素α-2b治疗宫颈高危人乳头瘤病毒(HPV)感染的临床效果和对免疫功能的影响。方法选取2018年6月至2020年6月本院收治的100例宫颈高危HPV感染患者作为研究对象,按照随机数字表法分为对照组与观察组,各50例。对照组予以宫颈环形电切术(LEEP)治疗,观察组在对照组基础上加用重组人干扰素α-2b治疗。比较两组HPV转阴率、免疫功能和并发症发生情况。结果术后3、6个月,观察组HPV转阴率均高于对照组,差异有统计学意义(P<0.05)。治疗前,两组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比较差异有统计学意义;治疗后,两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于治疗前,CD8^(+)均低于治疗前,且观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于对照组,CD8^(+)低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为16.00%,高于对照组的4.00%,差异有统计学意义(P<0.05)。结论重组人干扰素α-2b可改善宫颈高危HPV感染患者免疫功能,促进HPV转阴,减少术后并发症发生。

宫颈电环切术对妊娠时限及分娩方式的影响

目的:探讨宫颈上皮内瘤变患者行宫颈电环切术对妊娠时限、分娩方式及新生儿情况的影响。方法:选择因宫颈上皮内瘤变而行宫颈电环切术,于术后妊娠并分娩的32例产妇为研究组,同时取同期分娩且孕前未行任何宫颈手术的产妇64例为对照组,观察两组间的妊娠时限、分娩方式及新生儿出生体重等指标的差异。结果:两组资料可比性强。研究组早产3例,剖宫产16例,2例新生儿出生体重<2500g。对照组早产7例,剖宫产30例,6例新生儿出生体重<2500g。两组间早产率、剖宫产率、低出生体重儿率差异均无显著性(P>0.05)。结论:宫颈电环切术是治疗宫颈上皮内瘤变安全有效的方法,不会增加随后妊娠的剖宫产率、早产率和低出生体重儿率。

高危型HPV监测评估宫颈电环切术治疗宫颈上皮内瘤样病变

目的：探讨宫颈电圈环行切除术（LEEP）治疗宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）疗效，特别是高危型入乳头瘤病毒感染（HPV）是否消失，以此评估该治疗方法对CIN治疗的有效性。方法：对56例超薄液基细胞学（TCT）涂片异常并经阴道镜检病变小于2cm，组织学检查证实为CIN1～3的妇女实行了宫颈电圈环行切除术（LEEP），治疗后3个月随诊时再次行TCT检查并采用HC-2法检测高危型HPV。结果：①CIN1组HPV转阴率为72．5％（29／40），病变残留（切缘阳性）率为5％（2／40），病变残留与HPV持续阳性成正比。②CIN2～3组HPV转阴率为44％（7／16），病变残留率为31％（5／16），病变残留与HPV持续阳性成正比。③CIN1组治疗后HPV阴转率及病灶彻底切除率均高于CIN2～3组，经统计学处理有显著意义。结论：①高危型HPV感染率与CIN程度成正比，在CIN2～3中高于CIN1。②LEEP不仅可以有效的治疗CIN1，而且可以使其伴行的HPV感染消失；③LEEP治疗部分CIN2～3尚不够充分，应加大宫颈组织的切除范围和深度。④LEEP治疗后残留病变和HPV持续阳性密切相关；⑤TCT和HPV检测不仅可以评价宫颈疾病治疗效果而且可以作为CIN治疗后追踪随访的有效手段。

高危型人乳头状瘤病毒对评估宫颈电圈切除术治疗宫颈上皮内瘤样病变预后的意义

目的：探讨检测高危型人乳头状瘤病毒（HPV）对评估宫颈电圈切除术（LEEP）治疗宫颈上皮内瘤样病变（ON）预后的意义。方法：对560例经阴道镜下宫颈活检证实为CIN的患者进行LEEP治疗，治疗后随访1年．检测治疗前后高危型HPV的负荷量，对病灶持续存在或复发等情况进行回顾性分析总结。结果：术前病理为CINⅠ、CINⅡ和CINⅢ的三组患者，其高危型HPV感染率分别为32．63％、90．85％和98．13％。前组（低度宫颈上皮内瘤样病变组）与后两组（高度宫颈上皮内瘤样病变组）高危型HPV感染率差异均有统计学意义（P〈0．001），高危型HPV感染率随宫颈病变严重程度的加重而上升。术后6个月CINⅠ、CINⅡ、CINⅢ三组患者高危型HPV感染率分别为2．54％、12．80％和25．23％，术后1年三组患者高危型HPV感染率分别为0．88％、9．15％和22．43％，与术前比较，三组高危型HPV感染率均显著下降（P〈0．001）；CINⅠ、CINⅡ、CINⅢ三组患者术后的病变持续存在率分别为1．69％、6．71％和12．15％，复发率分别为0、7．32％和10．28％．前组与后两组术后病变的持续存在率和复发率差异存在显著性（P〈0．001），术后高危型HPV持续阳性可提示病变的持续存在或复发。结论：LEEP能显著降低CIN患者高危型HPV感染率，有效治疗宫颈上皮内瘤样病变．术后检测高危型HPV病毒负荷量能判断疾病预后。

子宫颈环形电切术对宫颈癌前病变200例疗效分析

目的探讨子宫颈环形电切术(LEEP)对宫颈癌前病变的疗效。方法选取200例宫颈上皮内瘤样病变(CIN)患者,均行LEEP治疗,观察并记录患者的手术时间、术中出血量、不同程度CIN患者治愈例数,对比患者术前阴道镜下宫颈活检和LEEP术后病理组织检查结果,记录随访1个月期间并发症情况。结果患者所需手术时间6~22 min,平均手术时间(7.9±1.8)min;术中出血量16~41 m L,平均术中出血量(21.3±8.9)min。术后病理结果证实:CINⅠ72例患者,全部治愈,治愈率100%,CINⅡ87例患者,治愈81例,治愈率93.1%,CINⅢ41例患者,治愈37例,治愈率90.2%。不同程度CIN患者治愈率相比,无统计学差异(P>0.05)。术前阴道镜宫颈活检与LEEP术后病理诊断结果比较,CINⅠ病理符合率94.1%,CINⅡ病理符合率83.5%,CINⅢ病理符合率74.5%,不同程度CIN的术后病理符合率相比,差异有统计学意义(P<0.05)。随访1个月,6例出现宫颈粘连,3例宫颈管狭窄,下腹坠痛伴烧灼感7例,并发症发生率8%。结论 LEEP对宫颈癌前病变具有较好的治疗与诊断效果,诊断效果好于术前阴道镜宫颈活检,术后创伤小,并发症少,值得临床推广使用。

LEEP术后患者宫颈长度变化与妊娠及不良结局分析

目的:探讨行宫颈环形电切术(LEEP)年轻患者术后宫颈长度变化及对妊娠结局的影响。方法:将2018年2月-2019年2月本院行LEEP术治疗的宫颈鳞状上皮内瘤变患者105例为病例组,随机选同期行孕前体检且无LEEP术史妇女42例为对照组。比较病例组LEEP术前和术后6个月宫颈长度,及两组妊娠及不良妊娠结局情况。结果:病例组患者LEEP术后6个月宫颈长度(28.13±2.36mm)短于术前(29.76±2.45mm),且孕前(28.2±2.3 mm)短于对照组(29.9±2.3mm)(P<0.05);术后妊娠者发生晚期流产率(18.0%)高于对照组(2.6%),早产率(41.0%)和未足月胎膜早破发生率(19.1%)高于对照组(4.8%、2.4%)(P<0.05)。结论:患者LEEP术后宫颈长度虽变短但仍可保存较好的生育功能,但宫颈长度变短可增加妊娠后晚期流产、早产和未足月胎膜早破等发生率,对有生育要求的患者应明确手术指征,尽可能多的保留宫颈组织以提高生育几率。

宫颈环形电切术并发症及对分娩期宫颈机能的影响

目的探讨宫颈环形电切(LEEP)术对分娩期宫颈机能的影响。方法将204例女性分为观察组和对照组,观察组LEEP术中宫颈切除深度为10~20mm,对照组LEEP术中宫颈切除深度为21~25mm,比较两组术后的随访结果。结果观察组术后出血量、手术时间、术后出血情况、术后感染皆与时照组无显著性差异(P>0.05)。术后1月、2月时,观察组宫颈修复情况优于对照组(x^2值分别为0.542、10.264,均P<0.05)。观察组术后宫颈狭窄情况轻于对照组(x^2=15.711,P<0.01)。术后1年分娩时,观察组宫颈裂伤、宫颈机能不全发生率低于对照组(x^2值分别为6.423、6.655,均P<0.05)。结论 LEEP术中宫颈切除深度对女性术后宫颈修复、宫颈狭窄的发病率、分娩时宫颈裂伤、宫颈机能不全的发生率影响较大,而20mm以下的切除深度对女性术后宫颈生理及机能的影响较小。

“即诊即治”法在宫颈高度鳞状上皮内瘤变诊治中的应用

目的:探讨"即诊即治"法在宫颈高度鳞状上皮内瘤变诊治中的应用。方法:选取宫颈高度鳞状上皮内瘤变患者152例,随机分成2组:A组67例给予"三阶梯"治疗,B组85例按"即诊即治"方法治疗,比较2组患者的治疗结果。结果:A组过度治疗率为8.9%,B组为9.4%,两组比较无显著差异。Reid阴道评分高者术后宫颈上皮内瘤变(CIN)Ⅱ以上A组为62.7%、B组为61.2%。结论:"即诊即治"法治疗宫颈高度鳞状上皮内瘤变具有"三阶梯"治疗相似的治疗效果,可减少复诊,具有便捷、实用的优点。

重组干扰素α-2b凝胶联合宫颈环形电切术治疗宫颈上皮内瘤变伴高危型人乳头瘤病毒感染的疗效

目的：探讨重组干扰素α-2b凝胶联合宫颈环形电切术（LEEP）治疗宫颈上皮内瘤变伴高危型人乳头瘤病毒（HR-HPV）感染的疗效。方法：选取74例就诊的CIN伴HR-HPV感染患者随机分为联合组和对照组各37例。两组均于月经后5~7d行LEEP术,联合组于LEEP术后3d予以重组干扰素α-2b凝胶1g/次,用推进器轻送入阴道后覆盖在宫颈表面,隔日1次,连用3个月,月经期停用。对照组患者除不使用重组干扰素α-2b凝胶治疗外,余治疗与联合组相同。观察并记录两组患者术后创面愈合时间和阴道流液时间,术后半年评估并比较CIN治疗效果及HPV清除率。结果：联合组患者治疗后阴道出血量少于对照组（χ^2=4.43,P〈0.05）,阴道出血时间短于对照组（χ^2=7.23,P〈0.05）;治疗后半年,联合组患者的CIN病变治愈率高于对照组,CIN病变持续或残存率低于对照组（χ^2=4.16,P〈0.05）,联合组患者HPV清除总有效率高于对照组（χ^2=5.23,P〈0.05）。结论：重组干扰素α-2b凝胶联合LEEP术治疗CIN伴HRHPV感染可加快术后创面愈合,减少阴道流液时间;并可提高CIN病变治愈率,减少其持续或残存率,更有效清除HPV感染。