宫颈环形电切术在子宫颈原位癌诊治中的临床价值  

Loop electrical excision procedure in the diagnosis and treatment of carcinoma in situ of cervix

作　　者：徐灵 徐军 

机构地区：[1]上海市闵行区中心医院,上海201199

出　　处：《上海医学》2013年第4期350-353,共4页Shanghai Medical Journal

摘　　要：目的探讨宫颈环形电切(LEEP)术在子宫颈原位癌诊治中的作用和临床价值。方法选取2009年1月―2011年1月在上海市闵行区中心医院经阴道镜指引行病灶点状活组织病理学检查诊断为宫颈原位癌的患者75例;均行LEEP术,其中35例选择术后随访,分别于术后3个月行宫颈细胞学(TCT)检查,术后6个月行高危人乳头瘤病毒(HR-HPV)及阴道镜检查;40例选择进一步手术治疗。结果 LEEP术后病理诊断与阴道镜病理诊断的符合率为80.0%(60/75)。34例随访24个月无需手术患者与41例进一步手术患者间术后3个月TCT异常检出率(P=0.893)、术后6(P=0.837)和12个月(P=0.847)的HR-HPV转阴率的差异均无统计学意义,而年龄(P<0.001)和妊娠次数(P=0.012)的差异均有统计学意义。行进一步手术的33例宫颈原位癌患者中,有无残留病灶者的年龄(P=0.414)、妊娠次数(P=0.101)的差异均无统计学意义;阴道镜检查前,TCT检查结果均为异常、HR-HPV均为阳性;有残留病灶患者LEEP术后病理诊断与术前阴道镜病理学检查结果的诊断符合率为33.3%(1/3),显著低于无残留病灶患者的96.7%(29/30,P=0.017),而进一步术后病理诊断与LEEP术后病理诊断均达100.0%(P>0.05);在进一步手术后的随访中,TCT、HR-HPV及阴道镜指引下病灶点状活组织病理学检查结果均正常。结论 LEEP术是一种有效诊断、治疗子宫颈原位癌的方法,尤其适用于有生育要求、年轻的患者,但需要密切随访。阴道镜指引下病灶点状活组织病理学检查联合LEEP术可作为诊断宫颈原位癌的金标准。Objective To evaluate the role of loop electrical excision procedure （LEEP） in diagnosis and treatment of carcinoma in situ of cervix （CIS）. Methods Seventy-five CIS patients, diagnosed via colposcopical biopsy in our hospital between January 2009 and January 2011, were recruited in this retrospective study. All patients received LEEP firstly. Then 35 patients chose to have close follow-up after LEEP while the other 40 patients receive further surgical treatment. TOT was performed at 3 months after LEEP, and high-risk human papilloma virus （HR-HPV） examination and colposcopy were conducted at 6 months after LEEP. Results The pathological diagnosis pre- and post-LEEP were accordant in 60 patients （80. 0%, 60/75）. There were no significant differences in TOT at 3rd month （ P = 0. 893） after LEEP or the negative rate of HR-HPV at 6th month （P=0.837） and 12^th month （P = 0. 847） after LEEP between 34 women in follow-up group and 41 women in hysterectomy group, but there were significant differences in age （ P〈0. 001 ） and number of pregnancies （ P = 0.012）. Among the 33 patients with hysterectomy, no statistical difference was found in age （P = 0. 414） or number of pregnancies （P = 0. 101 ）~ TCT was normal and HR-HPV test was positive before colposcopy examination. The accordance rate of pathological diagnosis after LEEP and colposcopy examination in the patients with lesion residual was significantly lower than those without lesion residual （33.3% E 1/31 vs. 96.7% E29/30~, P=0. 017）. The accordance rates of pathological diagnosis after LEEP and hysterectomy were all 100% （P~ 0.05）. The results of TCT, HR-HPV and colposcopy examination were normal after hysterectomy. Conclusion LEEP is effective in diagnosing and treating CIS, especially for those young and fertility-preserving patients. However, close follow-up after LEEP is required. Colposcopical biopsy plus LEEP is the golden standard in diagnosing CIS.

关 键 词：宫颈原位癌 宫颈环形电切术 人乳头瘤病毒 

分 类 号：R737.33[医药卫生—肿瘤]