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 (...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.展开更多
目的探讨宫颈病变患者行子宫颈电环切术(LEEP)的手术配合与护理。方法回顾性分析2003年5月至2004年12月本院门诊358例宫颈病变患者进行LEEP术治疗的临床资料。经宫颈薄层液基细胞学(LCT)、人乳头瘤病毒(HPV)检测阳性,阴道镜活检病理诊...目的探讨宫颈病变患者行子宫颈电环切术(LEEP)的手术配合与护理。方法回顾性分析2003年5月至2004年12月本院门诊358例宫颈病变患者进行LEEP术治疗的临床资料。经宫颈薄层液基细胞学(LCT)、人乳头瘤病毒(HPV)检测阳性,阴道镜活检病理诊断为宫颈上皮内瘤样病变(C IN)C IN I 17例、C IN II146例、C INIII 195例(原位癌13例)患者行LEEP,切除组织标记后均行病理检查。于术前和术后对患者进行护理宣教,并问卷调查。结果LEEP术后3个月随访C IN I 100%治愈,C IN II 98.6%治愈,C IN III 98.9%治愈,宫颈糜烂100%愈合,宫颈肥大89.8%完全恢复正常大小。术后6个月随访C IN 100%治愈。术后3、6、9、1 2个月随访患者HPV检测转阴率显著,13例原位癌术后随访1年正常。LEEP术手术时间短、出血少、治愈率高。系统宣教以后患者对宫颈病变的认知度显著提高。结论LEEP术是目前临床上治疗宫颈病变的有效方法之一,系统的护理可以提高患者对宫颈病变的认知度,促进患者康复。展开更多
文摘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.
文摘目的探讨宫颈病变患者行子宫颈电环切术(LEEP)的手术配合与护理。方法回顾性分析2003年5月至2004年12月本院门诊358例宫颈病变患者进行LEEP术治疗的临床资料。经宫颈薄层液基细胞学(LCT)、人乳头瘤病毒(HPV)检测阳性,阴道镜活检病理诊断为宫颈上皮内瘤样病变(C IN)C IN I 17例、C IN II146例、C INIII 195例(原位癌13例)患者行LEEP,切除组织标记后均行病理检查。于术前和术后对患者进行护理宣教,并问卷调查。结果LEEP术后3个月随访C IN I 100%治愈,C IN II 98.6%治愈,C IN III 98.9%治愈,宫颈糜烂100%愈合,宫颈肥大89.8%完全恢复正常大小。术后6个月随访C IN 100%治愈。术后3、6、9、1 2个月随访患者HPV检测转阴率显著,13例原位癌术后随访1年正常。LEEP术手术时间短、出血少、治愈率高。系统宣教以后患者对宫颈病变的认知度显著提高。结论LEEP术是目前临床上治疗宫颈病变的有效方法之一,系统的护理可以提高患者对宫颈病变的认知度,促进患者康复。
