宫颈环形电切术治疗宫颈上皮内瘤变224例临床分析_临床医学论文.docVIP

宫颈环形电切术治疗宫颈上皮内瘤变224例临床分析_临床医学论文 宫颈环形电切术治疗宫颈上皮内瘤变224例临床分析_临床医学论文 作者：肖锦艳，刘秋华，葛阳清，梁莹莹 【摘要】 目的 探讨宫颈环形电切术(LEEP术)治疗宫颈上皮内瘤变(CIN)的临床价值，以期对CIN的诊断及治疗提供一定的临床经验，达到早期预防宫颈癌变的目的。方法 回顾性分析了2006年1月至2009年1月岳阳市第二人民医院妇科门诊在阴道镜下多点活检术后病理诊断为CIN，继之行宫颈环形电切术(LEEP术)治疗的224例患者(CIN 222例，原位癌2例)的临床资料，对患者一般情况、术前阴道镜定位活检、术中情况、术后病检结果和随访资料进行统计分析。结果 (1)所有患者均于月经干净后3～7天手术，手术时间5～18 min，术中出血量平均13.1ml，患者反应轻。(2)术前术后宫颈环切组织病理结果比较：病理分级一致者136例(60.71%);级别下降者64例(28.57%);其余24例(10.71%)级别上升，其中2例术前为CINⅠ而术后证实为CINⅢ(不包括原位癌)，12例术后病检发现切缘有病变累及者，2例随后行全子宫切除，4例行2次LEEP术。(3)对所有患者定期随访至2009年1月，CIN治愈208例(93.69%),病变残留14例(6.31%)。CIN中7例(3.15%)术后12个月复发，均为CINⅠ，术后18个月后复发病变自然消退。结论 LEEP术是治疗CIN安全有效的方法，其治愈率高，术后并发症少，病变残留复发率低，值得临床推广。术后切缘累及情况是CIN残留复发的影响因素之一，术后需长期随访。 【关键词】 宫颈环形电切术;宫颈上皮内瘤变;治愈率 　　[Abstract] Objective To study the clinical effect of LEEP to CIN.It can offer some clinical experience to the diagnosis and treatment to CIN to prevent early cancer.Methods A retrospective analysis was conducted on LEEP in 224 cases of CIN after multiple punch biopsy under colposcopy treatment in the Second People’s Hospital of Yue yang in Hunan between January 2006 and January 2009.The operative time,intraoperative blood loss，colposcopic site-specific biopsies and follow-up data were retrospectively analyzed.Results (1)The mean operative time was 5～18 min，the operaive blood loss was 13.1 ml，and the reaction was light.(2)Histologic findings revealed that 60.71%(136/224) CIN grade was remained the same,28.57%(64/224)CIN was grade lowed and 10.71%(24/224) CIN grade was gone up，of which two cases of CINⅠ was confirmed to CINⅢ,compared with biopsy-confirmed CIN.12 positive margins were found，and hysterectomy was performed in 2 of 12 cases with positive margins，so did 4 secondary LEEP.(3) The cure rate was 93.69%;The residual rate was 6.31%;The recurrence rate was 3.15% when all patient were followed up regularly by January 2009.Conclusion LEEP is a kind of safe and effective method for treatment of CIN.It has a high cure rate and less postoperative complication