子宫颈环形电切术与CO2激光汽化治疗子宫颈上皮内瘤样病变Ⅱ级的疗效对比研究  

Comparative study on the effects of LEEP and laser CO2 vaporization in cervical intraepithelial neoplasia Ⅱ

作　　者：孙璐璐[1] 曹冬焱[1] 卞美璐[2] 魏丽惠[3] 杨佳欣[1] 杨丽[4] 成宁海[1] 王有芳[1] 程雪梅[1] 虎丽军[1] 郎景和[1] 沈铿[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,100730 [2]中日友好医院妇产科 [3]北京大学人民医院妇产科 [4]北京第四医院妇产科

出　　处：《中华医学杂志》2010年第43期3031-3034,共4页National Medical Journal of China

基　　金：国家“十一五”重点支撑项目（2008BA157B00）,北京市科技计划项目（D0906008040391）

摘　　要：目的多中心研究评价子宫颈环形电切术（LEEP）与CO2激光汽化治疗宫颈上皮内瘤样病变Ⅱ级（CINⅡ）的疗效及并发症。方法对因宫颈脱落细胞学异常行阴道镜检查及宫颈活检病理证实为CINⅡ患者338例，分别采用LEEP术（195例）和CO2激光汽化治疗（143例），术后进行3、6及12个月随访，比较治疗效果。结果LEEP组195例患者，治愈174例（89．2％）、病变持续8例（4．1％）、复发7例（3．6％），激光组143例患者，治愈124例（86．7％）、病变持续7例（4．9％）、复发1例（0．70％），两组比较差异均无统计学意义（均P〉0．05）。LEEP组在痊愈时间、手术次数、术中出血量与激光组比较差异有统计学意义（P〈0．05）。结论LEEP与CO2激光汽化治疗CINⅡ都是安全有效的方法，但LEEP可获得宫颈组织标本进行病理检查。治疗前疾病状态的准确评估及术后规范随访在治疗中有重要作用。Objective To compare the effect and complications of loop electro-surgical excision procedure （LEEP） and laser CO2 vaporization in the treatment of cervical intraepithelial neoplasia Ⅱ.Methods A total of 338 CIN Ⅱ women were recruited into this multi-center comparative study. The diagnosis was confirmed by histopathological examinatio n for cervical epithelial cell abnormalities. And colposcopic examination was submitted to LEEP（ n = 195 ） or laser CO2 vaporization（ n = 143 ） respectively. A post-treatment follow-up of 3, 6 and 12 months was carried out to compare the effect of two methods. Results Among 195 women undergoing LEEP, the frequency of cure, persistent and recurrent CIN was 89. 2% （n =174）, 4. 1% （ n = 8 ） and 3. 6% （ n = 7 ） respectively. And among 143 women receiving laser CO2 vaporization, the frequency of cure, persistent and recurrent CIN was 86. 7% （ n = 124）, 4. 9% （ n = 7 ）and 0. 70% （n = 1 ） respectively. There was no statistical difference in cure rates, persistence or recurrence of CIN （P 〉 0. 05 ）. The recoverytime, the operative frequency and intra-operative blood loss were significantly different in two groups. Conclusion Both LEEP and CO2 vaporization are both effective and reliable for the treatment of cervical intraepithelial neoplasia Ⅱ. However, pathological specimens may be harvested during LEEP. It is of vital importance to conduct preoperative colposcopie assessment and standard postoperative follow-ups.

关 键 词：宫颈上皮内瘤变 Ⅱ级 电外科手术 激光 汽化 

分 类 号：R686[医药卫生—骨科学]