宫颈环形电切术在宫颈原位癌诊治中的应用545001广西医科大学第.DOC

HYPERLINK mailto:yanmingj@126.com yanmingj@126.com 宫颈环形电切术在宫颈原位癌诊治中的应用 545001 广西医科大学第五附属医院 柳州市人民医院 蒋燕明 杨岚 李立 [摘要]:目的:研究宫颈环形电切术（LEEP）宫颈原位癌诊治中的应用价值。方法: 回顾性分析2003年7月至2008年1月在我院妇科确诊为34 例原位癌患者的临床表现、诊断方法、手术方式、病理结果及预后情况。结果:阴道镜检查下宫颈活检未诊断为原位癌患者有18例患者，占52.9％（18/34）。LEEP术后2例切缘有残留病变，占5.9％（2/34）。27例无生育要求在LEEP术后行全子宫切除术，7例有生育要求而密切随访。术后随访4一55个月，均无复发。结论:宫颈原位癌的确诊应通过宫颈锥切手术，对于年轻的宫颈原位癌可以行单纯的LEEP手术治疗，以保留生育功能。 [关键词]: 宫颈原位癌 全子宫切除手术 宫颈环形电切术 Application of loop electrosurgical exicision Procedure in the diagnosis and treatment for cervical carcinoma in situ JIANG Yan Ming, YANG Lan,LILi(Department of Gynecology,Fifth Affiliated Hospital ,Guangxi Medical University ,Liuzhou 545001,China) [Abastract] Objective To evaluate the value of loop slectrosurgicat excision procedure ( LEEP) for the management of cervical carcinoma in situ. Methods Thirty four cases of CIS which were diagnosed preoperatively and treated in our hospital from 2003 to 2008 were analyzed retrospectivel. Results 18 of the patients underwent colposcopic biopsy (52.9% ) were misdiagnosed . 2 of the patients(5.9%) have residual margin after LEEP.27 cases without fertility requirement were treated by hysterectomy，7 cases who want to preserve their fertility were followed up after LEEP conization for 4-55 months,there was no recurrence. Conclusions Loop electrosurgical excison procedure（LEEP）is recommended for pathologically diagnosed CIS before the operation to exclude those invasive carcinoma. LEEP also is suitable for the young CIS women who want to preserve their fertility . [Key words]：carcinoma in situ；hysterectomy；LEEP 宫颈癌是妇科最常见的恶性肿瘤，占女性生殖道恶性肿瘤的半数以上，严重威胁广大妇女的身心健康。随着宫颈细胞学检查及阴道镜技术的提高，宫颈原位癌(carcinoma in situ, CIS)在临床上也愈来愈常见。对于年轻的宫颈原位癌的患者如何保留生育功能是临床医生及患者关注的焦点[1,2]，对于宫颈原位癌的治疗是不是可以用宫颈环形电切术（LEEP）代替子宫全切手术也一直有争议。本文就我院34例宫颈原位癌行宫颈环形电切术病例进行回顾性分析，以探讨LEEP在宫颈原位癌中的应用。 1 资料与方法 1.1 资料 2003年7月至2008年1月在我院妇科确诊为原位癌的住院患者34 例，年龄21 -45（平均33.7）岁，未生育7例。临床表现有性交后出血11例，白带增多15例，阴道不规则出血8例。宫颈细胞学涂片:未明确诊断意义的不典型鳞状细胞( atypical squamous cell一un