子宫颈环形电切术治疗宫颈上皮内瘤变及原位癌160例临床分析  

Clinical analysis on 160 cases of cervical intraepithelial neoplasia and carcinoma in situ treated by loop electrosurgical excision procedure

作　　者：付俊生[1] 陈达丽[1] 彭鸿灵[1] 

机构地区：[1]贵州省人民医院妇产科,贵州贵阳550002

出　　处：《中国妇幼保健》2009年第25期3501-3504,共4页Maternal and Child Health Care of China

摘　　要：目的:探讨子宫颈环形电切术(LEEP)在治疗宫颈上皮内瘤变(CIN)及原位癌的临床意义。方法:回顾性分析2006年8月～2008年4月该院妇科门诊经主诉或检查判定为CIN或原位癌160例门诊患者进行LEEP治疗,并观察术中出血情况、病理标本与活检标本对照情况、高危型HPV感染率、随访结果。结果:①术中出血5～200ml,平均27.38ml。②CINⅠ宫颈活检与LEEP术的标本病理检查符合率83.02%,CINⅡ符合率76.92%,CINⅢ符合率48.00%,原位癌符合率80.00%,浸润癌检出7例(4.38%)。LEEP术后处理:56例行子宫全切(其中CINⅡ2例,CINⅢ22例,原位癌32例),7例浸润癌全部行广泛子宫切除与盆腔淋巴清扫术。③随访中创面出血9例出现阴道出血如月经量,检查发现多为子宫颈3、6、9点处结痂脱落所致,局部敷云南白药、沙布压迫止血,其中4例再次LEEP电凝止血,2月后复查全部愈合。2例宫颈口外翻,38例出现外阴瘙痒、感染和轻微下腹疼痛,经药物治疗均治愈。其中1例原位癌保留部分宫颈足月妊娠剖宫产娩出一女婴。④高危型HPV感染与预后:随访的104例病人中,高危型HPV阳性与阴性组比较,12例复发者均为HPV阳性。阴性者在随访中无一例复发,差异具统计学意义(P<0.001)。结论:LEEP术在诊断和治疗CIN中具有重要价值,能改善TCT和阴道镜下定点活检带来的误诊和漏诊,有效阻断癌前病变发展为浸润癌和对疾病程度的过高判断。高危型HPV阳性可作为判断是否有病变复发和残留的指标,若术后存在高危型HPV感染,则需要进一步行LEEP术治疗以免复发。Objective： To explore the clinical significance of loop electrosurgical excision procedure （LEEP） in the treatment of cervical intraepithelial neoplasia （CIN） and carcinoma in situ （CIS） . Methods： 160 cases diagnosed as CIN or CIS underwent LEEP from August 2006 to April 2008, the data were analyzed retrospectively ; the amount of bleeding during surgery, complications aftdr surgery, comparison between pathological specimens and biopsy specimens, infection rate of high risk HPV and results of follow - up were observed. Results： （1）Bleeding amount during surgery ranged from 5 to 200 ml, 27.38 ml on average. （2）The coincidence rate of CIN Ⅰ , CIN Ⅱ , CIN Ⅲ and CIS were 83.02% , 76. 92%, 48.00% and 80.00% , respectively. 7 cases （4. 38% .） were diagnosed as infiltrating carcinoma. Treatment after LEEP： 56 cases （2 cases of CIN Ⅱ , 22 cases of CIN Ⅲ, 32 cases of cIs） underwent hysterectomy, while 7 cases with infiltrating carcinoma underwent extensive hysterectomy and pelvic lymphadenectomy. （3）During the follow - up, 9 cases had colporrhagia equal to menstrual blood volume owing to incrustation exfoliation of three, six and nine point of cervix. Yunnan white powder and compressing bandages were locally used to stop bleeding, LEEP electric coagulation haemostasis had to be carried out again to 4 cases of them. Finally, all the cases healed well after two months. 2 cases had cervix eversion. One case of CIS deliveried a girl with partly cervix remained. 38 cases had pruritus of vagina and infections, all were cured by medicines. （4）HPV infection and prognosis： 104 cases were followed up, and all the recrudescent 12 cases were HPV positive. There was significant significance between HPV positive cases and HPV negative cases （P 〈 0. 001 ） . Conclusion： LEEP is of great value in the diagnosis and treatment of CIN, which can reduce the missed diagnosis and misdiagnosis caused by TCT and colposcope; it can also prevent the development of CIN to infiltrating c

关 键 词：宫颈上皮样变 原位癌 子宫颈环形电切术(LEEP) 

分 类 号：R711.74[医药卫生—妇产科学]