冷刀与电刀诊治宫颈上皮内瘤变的疗效及妊娠结局的对比  

Comparison of clinical effects and pregnancy outcomes after treatment of cervical intraepithelial neoplasis by loop electrosurgical excision procedure or cold knife conization

作　　者：蔡东阁[1] 赵金燕[1] 樊江波[1] 万秋园[1] 赵晓桂[1] 

机构地区：[1]西安交通大学医学部第二附属医院妇产科,陕西西安710004

出　　处：《西安交通大学学报（医学版）》2015年第5期677-681,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的探讨环形电切术（loop electrosurgical excision procedure,LEEP）与冷刀宫颈锥切术（cold-knife conization,CKC）在宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）诊治中的疗效对比及其对妊娠的影响。方法回顾性分析2010年1月-2012年1月间115例CIN患者的病历资料,其中行LEEP术的患者64例,行CKC术的患者51例,对两组方法的术中情况、手术并发症及术后病理结果进行比较,并追踪随访,比较行不同手术方法的两组患者复发情况、宫颈长度、妊娠情况和妊娠结局。结果手术时间LEEP组（12.56±3.09）min,比CKC组的（23.82±3.42）min短（P〈0.05）;术中出血LEEP组（9.78±3.77）mL,较CKC组的（26.35±9.26）mL少（P〈0.05）;LEEP组术后并发症发生率（7.81%）较CKC组（31.37%）低（P〈0.05）;两组术后病检一致率（87.42%vs.85.65%）、切缘阳性率（1.56%vs.1.96%）、术后复发率（3.13%vs.1.96%）、术后宫颈长度变化（1.40±0.24 vs.1.44±0.24）差异无统计学意义（P〉0.05）;LEEP组中妊娠率（87.50%）、流产率（3.12%）、胎膜早破发生率（7.81%）、早产率（6.25%）、新生儿低体重出生率（10.71%）与CKC组妊娠率（88.24%）、流产率（3.92%）、胎膜早破发生率（3.92%）、早产率（5.88%）、新生儿低体重出生率（11.11%）相比较,差异均无统计学意义（P〉0.05）。结论应用LEEP施行宫颈锥切术在手术时间、术中出血及术后并发症方面优于CKC,而对患者的术后复发情况、生育能力及妊娠结局无明显影响,诊治CIN的临床疗效与CKC相似,应得到临床的重视和应用。Objective To observe the clinical effects and pregnancy outcomes after treatment of cervical intraepithelial neoplasia（CIN）by loop electrosurgical excision procedure（LEEP）and cold knife conization（CKC）.Methods We made a retrospective analysis of the clinical data of 115 cases diagnosed as CIN by biopsy and pathological examination under colposcope from January 2010 to December 2011,in which 64 cases received LEEP and 51 cases received CKC. We compared the operation time,the amount of intraoperative blood loss,postoperative complications,recurrence rate and cervical length after operation in the two groups.Totally 115 cases were followed up after operation,and healthy outpatient women were randomly selected as controls.The incidence of parturition and pregnancy outcomes were compared between the groups.Results The operation time in LEEP group was（12.56±3.09）minutes,which was shorter than that in CKC group [（23.82±3.42）minutes]（P0.05）.The amount of intraoperative blood loss in LEEP group was（14.52±10.78）mL,which was lower than that in CKC group[（26.35±9.26）mL]（P0.05）.The incidence of complications after operation in LEEP group was7.81%,which was lower than that in CKC group（31.37%）（P0.05）.However,LEEP group and CKC group did not differ significantly in the incidence of pathologic diagnosis consistency before and after operation（87.42%vs.85.65%）,lesions in the incision edge（1.56% vs.1.96%）,recurrence（3.13% vs.1.96%）,premature rupture of membranes（7.81% vs.7.84%）,preterm birth rate（6.25% vs.5.88%）,or low birth weight rate of newborns（10.71% vs.11.11%）（P0.05）.Similar results were found between LEEP group and CKC group and control group（P0.05）.Conclusion The operation time,the amount of intraoperative blood loss and the incidence of complications after LEEP are superior to those of CKC;neither of them affects the incidence of parturition,fertility or pregnancy outcomes.LEEP should be given more attention in its clinical application in treat

关 键 词：宫颈上皮内瘤变 电刀 冷刀 妊娠结局 

分 类 号：R713.4[医药卫生—妇产科学]