光动力疗法与子宫颈环形电切术治疗宫颈上皮内瘤变2级的疗效对比  

Comparative study on the efficacy of photodynamic therapy and loop electrosurgical excision procedure in the treatment of grade 2 cervical intraepithelial neoplasia

作　　者：孙俊杰[1] 郭素杰[1] 李洪林[1] 岳莹莹 王兴芬[2] SUN Junjie;GUO Sujie;LI Honglin;YUE Yingying;WANG Xingfen(Department of Gynecology,the Second Hospital of Tianjin Medical University,Tianjin 300211,China;Department of Pathology,the Second Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院妇科,300211 [2]天津医科大学第二医院病理科,300211

出　　处：《天津医药》2024年第5期509-513,共5页Tianjin Medical Journal

基　　金：天津市卫生局科技基金资助项目(2013KZ108)。

摘　　要：目的评价光动力疗法与宫颈环形电切术(LEEP)治疗宫颈上皮内瘤变2级(CIN2)的疗效及不良事件的发生情况。方法40例CIN2级患者依治疗方案不同分为光动力组20例和LEEP组20例,于治疗后3、6及12个月进行随访,比较2组患者高危型HPV病毒(HR-HPV)、阴道微生态、阴道镜检查和宫颈活检情况,记录不良事件发生情况。结果2组间患者治疗后3个月的病变逆转、病变残留及病变进展构成差异无统计学意义。光动力组治疗后6个月时1例复发者和LEEP组治疗后12个月时1例复发者的宫颈活检病理均为CIN1级。2组患者治疗后3、6及12个月HR-HPV转阴率、正常阴道微生态比例差异无统计学意义。光动力组治疗后3、6、12个月患者的正常阴道微生态比例呈依次增高的趋势。在治疗过程中,光动力组患者疼痛能忍受,LEEP组疼痛明显并伴有出血;2组治疗后均有阴道分泌物增多、下腹坠痛,但LEEP组有宫颈局部瘢痕形成并有1例出现阴道出血。结论光动力疗法治疗CIN2效果较好,HR-HPV转阴率高,对宫颈几乎无损伤,尤其适用于有生育要求的患者。Objective To evaluate the efficacy and incidence of adverse events of photodynamic therapy and loop electrosurgical excision procedure(LEEP)in the treatment of grade 2 cervical intraepithelial neoplasia(CIN2).Methods Forty CIN2 patients were divided into the photodynamic group(20 cases)and LEEP group(20 cases)according to different treatment options.Follow ups were conducted at 3,6 and 12 months after treatment.High-risk HPV virus(HR-HPV),vaginal microbiota,colposcopy examination and cervical biopsy results were compared between the two groups.Adverse events were recorded.Results There was no significant difference in the composition of lesion reversal,residual lesions and progression after 3 months of treatment between the two groups of patients.After 6 months of treatment,one case relapsed in the photodynamic group,and 12 months after treatment one case relapsed in the LEEP group.Both cases of cervical biopsy pathology were CIN1 grade.There were no significant differences in the conversion rate of HR-HPV and the proportion of normal vaginal microbiota between the two groups of patients at 3,6,and 12 months after treatment.The proportion of normal vaginal microbiota in the photodynamic group increased sequentially at 12 months after treatment compared to 3 and 6 months after treatment.During the photodynamic treatment,the pain was tolerable in the photodynamic group,while in the LEEP group,the pain was obviously accompanied by bleeding.After treatment,patients in both groups had increased vaginal discharge and lower abdominal pain,but in the LEEP group,local cervical scars formed and one case experienced vaginal bleeding.Conclusion Photodynamic therapy is effective on treating CIN2,with a high negative conversion rate of HRHPV and almost no damage to the cervix,especially suitable for patients with fertility requirements.

关 键 词：宫颈上皮内瘤样病变 光动力疗法 宫颈环形电切术 

分 类 号：R739.9[医药卫生—肿瘤]