高频电波刀治疗宫颈疾病的临床价值及术后HPV检测的临床意义  

Clinical value of LEEP in treatment of cervical diseases and clinical significance of postoperative HPV detection

作　　者：李玉霞[1] 杨蓉[1] 曹江霞[1] 严春香[1] 

机构地区：[1]湖北省武汉市妇女儿童医疗保健中心,430010

出　　处：《中国妇幼保健》2010年第33期4933-4935,共3页Maternal and Child Health Care of China

摘　　要：目的：探讨高频电波刀（LEEP）治疗宫颈疾病的临床价值及术后HPV检测的临床意义。方法：回顾性分析2006年10月～2009年3月在武汉市妇女儿童医疗保健中心妇产科接受LEEP手术治疗的139例患者的术中出血量、术后病理结果及随访情况。结果：139例患者的术中平均出血量12．60ml（2～80m1）。术前术后病理级别一致者89例（64．03％），级别上升者26例（18．71％），级别下降者24例（17．27％）。术后随访12—18月98例，术后病理检查切缘阳性6例（4．23％），其中4例复查HPV—DNA阳性而行二次手术，另外2例HPV—DNA阴性随访2年无病灶复发；3例（2．16％）术后发生宫颈粘连（CINIⅡ例、CINⅡ例），其中1例伴宫颈狭窄；TCT复查为炎症9例（6．47％），HPV—DNA阳性；1例术后复查为CINⅡ同时HPV—DNA阳性，应本人要求行全子宫切除术，术后病检未见癌变。结论：高频电波刀对诊断和治疗宫颈疾病有较高的临床价值。若正确掌握手术指证，规范手术操作步骤，则不影响病理学诊断，并可弥补阴道镜下活检的局限性。而术后HPV检测对预测病灶残留和复发有重要的临床意义。Objective ： To explore the clinical value of LEEP in treatment of cervical diseases and clinical significance of postoperative HPV detection. Methods： The intraoperative blood loss, postoperative pathological results and follow up results of 139 patients with cervical diseases receiving LEEP in the hospital from October 2006 to March 2009 were analyzed retrospectively. Results： The intraoperative blood loss was 12. 60 ml （2 - 80 ml） on average; 89 cases （64. 03 % ） had the same pathological grades before and after operation, 26 cases （ 18. 71% ） graded up, 24 cases （ 17. 27% ） graded down; 98 cases were followed up for 12 - 18 months, 6 cases had positive margin which were confirmed by postoperative pathological examination, 4 cases had positive HPV - DNA after reexamination, then secondary operation was conducted, and no recurrence was found in the other two cases with negative HPV - DNA after follow - up for two years ; postoperative cervical adhesion occurred in 3 eases （2. 16% ） （1 case of CIN I and 2 cases of CINⅡ） , including 1 case with cervical stenosis; 9 cases （6. 47% ） with positive HPV- DNA were diagnosed as inflammation after TCT reexamination; 1 case with positive HPV- DNA were diag- nosed as CIN Ⅱ, total hysterectomy was conducted as requested, no carcinogenesis was found during postoperative pathological examination. Conclusion： LEEP is a valuable method for diagnosis and treatment of cervical diseases. Grasping proper operative indications and normative operative procedures do not affect pathological diagnosis and can overcome the limitations of biopsy under colposcope ; postoperative HPV detection has an important clinical significance to predict residual lesions and recurrence.

关 键 词：高频电波刀 宫颈疾病 HPV检测 临床意义 

分 类 号：R713.4[医药卫生—妇产科学]