摘要
目的探讨采取不同切除方式及切除范围宫颈环形电圈切除术（loop electrocautery excision procedure，LEEP）治疗不同程度宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）及其相关问题。方法对2006年2月至2009年10月在济南军区总医院妇科治疗的446例不同程度CIN患者（CINⅠ为108例，CINⅡ为232例，CINⅢ为106例）的完整临床资料（LEEP不同切除方式及切除范围后的随访结果，包括愈合及不良反应发生情况）进行回顾性分析。对其平均随访时间为（24．5±5．5）个月（8～32个月）。按照治疗时采取的LEEP术式，将其分为4组。①采取LEEP锥形高帽状切除法切除2／3以上的宫颈组织治疗CINⅡ～Ⅲ患者，纳人A组（n=109）；②采取LEEP环形蘑菇式切除法切除1／3到2／3的CINⅠ～Ⅱ患者，纳入B组（n=203）；③将采取LEEP环形浅蘑菇式切除法切除1／3以下的cINⅠ和／或有生育要求患者，纳人C组（n=90）；④将采取LEEP削果皮式切除法的CINⅠ或疑似CINⅠ和有生育要求患者，纳入D组（n=44）。4组均采用球形电极电凝病变区域止血（本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，并与受试对象签署临床研究知情同意书）。结果本组患者术前宫颈多点活检和LEEP后切除组织病理学检查结果符合率为87．4％（390／446），不符合率为12．5％（56／446）。其中，术后切除组织病理学检查结果较术前宫颈多点活检结果加重为6．5％（29／446）。A，B，C和D组：①治愈率分别为99．1％（108／109），98．5％（200／203），100．0％（90／90）和93．2％（41／44）。②组织愈合时间分别为（7．5±1．0）周，（6．5±0．5）周，（5．5±0．5）周和（4．5土0．5）周。⑧术中出血量分别为（58．4±23．8）mL，（29．94-12．3）mL，（11．1±3．8）mL和（4．0±1．4）mL。本组56例有生育要求患者的CIN级别分别为CINⅠ31例，CINⅡ14例和CINⅡ～Ⅲ11例，接受不同LEEP后，对其随访时间〉2年的妊娠率分别为80．6％（25／31），71．4％（10／14）和27．3％（3／11）。结论不同LEEP术式切除的宫颈组织大小、愈合时间及并发症发生率均有差异。应根据不同程度宫颈上皮内瘤变采用相应LEEP术式，避免过度切除宫颈组织，以保护宫颈功能，提高疗效。
Objective To investigate the related issues of different section types and extent of loop electrosurgical excision procedure （LEEP） for the treatment of different degrees of cervical intraepithelial neoplasia（CIN）. Methods Four hundred and forty six patients with CIN （108 patients with CIN Ⅰ , 232 ones with CIN Ⅱ and 106 ones with CIN Ⅲ） who were treated in the department of gynecology of Jinan Military Hospital since February 2006 to October 2009, were retrospectively studied their clinical materials, in which included healing process and side effect in the different section type and extent of LEEP. The mean follow-up times was（24.5±5.5） months （range from 8 to 32 months）. The types and indications of LEEP we used in this study included： （1）group A（n= 109） ： ≥2/3 cervical surface area was cut off like cone-shape, for the 109 patients with CIN Ⅱ-Ⅲ （2）group B（n=203） ： ≥1/3 to ≤2/3 one was cut off like mushroomshape, for the 203 patients with CIN Ⅰ -Ⅱ （3）group C（n=90） ： ≤1/3 one was cut off like ring - shallow -mushroom-shape, for the CIN Ⅰ who wished to give-birth; （4）group D （n=44）： peeling cervical rind, for the CIN Ⅰ or doubtful CIN Ⅰ who wished to give-birth. All bleeding spots were coagulated for hemostasis using spherical electrode. All patients gave and signed informed consent and the study was approved by the Institutional Review Board of the Jinan Military General Hospital. Informed consent was obtained from all participates. Results The correspond rate of the tissue pathological-results after LEEP to the multi-spotbiopsy pathological-results before LEEP was 87. 4% （390/446）, the noncoineidence rate was 12. 5 （56/ 446）, among them there were 6. 5% （29/446） aggravated results. In this study of the A, B, C and D groups： （1）the total cure rate of LEEP for different CIN were respectively 99. 1% （108/109） in group A, 98.5% （200/203） in group B, 100.0% （90/90） in group C and 93.2% （41/44） in group D. （2）The cervical healing-times of group A to D were （7.5±1.0） weeks, （6.5±0.5） weeks, （5.5±0.5） weeks and （4.5± 0.5） weeks, respectively. （3）The lose blood of group A to D were （58.4±23.8） mL, （29.9±12.3） mL, （ 11.1 ± 3.8） mL and （4.0± 1.4） mL, respectively. The 56 patients who wished to give-birth were 31 ones with CIN Ⅰ , 14 with CIN Ⅱ and 11 with CIN Ⅱ-Ⅲ. After more than Z years of follow-up, the pregnancy rates were respectively 80.6%（25/31）,71.4%（10/14）and 27.3%（3/11）. Conclusion Treatment for CIN by LEEP typy should be individualized, according to different degrees.
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2011年第5期333-337,共5页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
国家卫生部科研基金项目资助(WKJ2007-3-001)~~
关键词
环形电圈切除术
宫颈上皮内瘤变
疗效
术式
loop electrosurgical excision procedure
cervical intraepithelial neoplasia
curative effect
operating type
