宫颈锥形切除术诊治宫颈上皮内瘤变的临床价值(附303例报告)  

The clinical study of performing conization to diagnose and treat the cervical intraepithelial neoplasia:a report of 303 cases.

作　　者：曹树军[1] 朱凌[1] 钱金风[1] 万小平[2] 

机构地区：[1]上海市松江区中心医院上海交通大学附属第一人民医院松江分院妇产科,上海201600 [2]上海交通大学附属第一人民医院妇产科

出　　处：《现代妇产科进展》2009年第10期749-753,共5页Progress in Obstetrics and Gynecology

基　　金：上海市松江区医学领先专业建设资助项目(No:05Ⅰ--04)

摘　　要：目的:探讨宫颈锥形切除术诊治宫颈上皮内瘤变(CIN)的实用价值。方法:2005年2月～2007年12月经阴道镜多点活检病理检查诊断为CIN并实施宫颈LEEP术271例(LEEP组);CIN同期实施宫颈冷刀锥切术(CKC)32例(CKC组),随访治疗效果。结果:(1)LEEP组手术时间和术中出血量分别为9.3±5.1m in和14.4±13.8m l;CKC组为29.4±15.3m in和68.6±31.8m l,均高于LEEP组(P<0.01);(2)LEEP后宫颈病变级别升高23例(8.5%),完全符合131例(48.3%),降低117例(43.2%);CKC组分别为8例(25.0%)、20例(62.5%)、4例(12.5%);两组有显著差异(P<0.01);(3)LEEP组术后切缘阳性11例,病灶残留2例;切缘阴性260例,病灶残留3例;CKC组术后切缘阳性1例,无病灶残留;切缘阴性31例,病灶残留1例。各组子宫切除标本病理诊断级别再无升高病例;(4)随访期间LEEP组复发3例,余者无复发。LEEP组、CKC组治愈率分别为95.2%(139/146)、96.7%(29/30)。结论:LEEP治疗宫颈病变不仅可完整切除病灶,而且能消毁切缘病灶,消除宫颈HPV负荷,疗效肯定,简便易行。高级别CIN治疗前需要先行LEEP预处理,这对早期发现宫颈浸润癌有重要意义。Objective：To study the practical value of performing loop electrical excision procedure（LEEP） to diagnose and treat the patients of cervical focus. Methods： Two hundred and seventy-one cases of cervical intraepithelial neoplasia（CIN） who were diagnosed by colposcope including muhi-biosy pathological examination and then performed LEEP as LEEP group from Feb. 2005 to Dee. 2007 in our hospital, 32 cases of CIN who were performed cold knife conization in the mean time as CKC group. The effect of treatment was followed up and observed. Results：The operation lasted 9.3±5.1min and the amount of bleeding was 14.4±13.8ml in LEEP group. However,they were 29.4±15.3min and 68.6±31.8ml in CKC group,which were higher than LEEP group（P〈0.01）. There were 23 cases （8.5%） ascended,131 cases（48.3%） absolutly coincided, 117 cases （43.2%） descended in the classification of cervical focus after LEEP,while in CKC group there were 8 cases（25.0% ） ascended,20 cases（62.5% ） coincided, 4 cases（12.5% ） decended,there was obvious difference between these two groups（P〈0.01）. There were 11 cases with the edge of cutting（＋） ,including 2 cases with focus remained,260 cases with the edge of cutting （-）, including 3 cases with focus remained after LEEP in LEEP group. While in CKC group, there was 1 case with the edge of cutting （＋）, no focus remained, 31cases with the edge of cutting（-） ,including 1 ease with focus remained. There was no case ascended in the classification of pathological diagnosis to the specimen of uterus removed in each group. There were 3 cases recurred in LEEP group,hut no case recurred in the rest of cases during followed-up. The cure rates in LEEP group anti CKC group were 95.2%（139/146）,96.7% （29/30）. Conelusions：LEEP can not only cut focus completely,hut also eliminate the edge of cutting with it and the burden of HPV in the cervix,its effeet is sure and the procedure is easy to carry out. It＇s necessary lo pevfortn LEEP for preconditio

关 键 词：宫颈肿瘤 癌前状态 宫颈上皮内瘤样病变 宫颈电环切除术 

分 类 号：R737.33[医药卫生—肿瘤]