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目的:探讨宫颈环切术(loop electro-surgical excisional procedure,LEEP)在宫颈上皮内瘤变(CIN)中的诊断和治疗价值。方法:回顾性分析2008年1月至2009年月12月因宫颈上皮内瘤(cervical intraepithelial neoplasia,CIN)治疗的597例的情况。在充分知情的前提下按自愿的原则,分为子宫全切组65例(对照组)和LEEP组532例(治疗组)。结果:两组术后均未发现复发,无显著性差异(P>0.05)。597例宫颈上皮内瘤变(CIN)患者术前术后病理检查符合率为:等级(一致)48.58%,降级40.03%(术后病检为慢性宫颈炎占8.21%),升级11.39%。LEEP术后排除宫颈癌后切缘阳性的有27例,其中13例行子宫切除术,8例行二次LEEP,术后切缘均阴性,6例行保守性随访,半年至一年均转阴。讨论:LEEP治疗CIN安全有效,微创、并发症少,在治疗的同时能进行诊断,弥补了阴道镜下活检的不足。LEEP符合生理要求,治疗了疾病同时又保留了患者生殖器的完整性,给年轻患者保留了生育功能且不影响妊娠。操作简单易行,恢复快治愈率高,可在门诊手术,无需住院,费用低,患者易接受。切缘阳性CINⅢ级患者在日后的随访中并未发现病灶持续存在或复发,因此对LEEP术后病理升级或切缘阳性者排除宫颈癌后,可行二次LEEP或严格随访观察,防止过度治疗。只要严格随访,CINⅢ级保守性治疗的适应症可扩大到切缘阳性患者,但要在充分知情前提下根据患者年龄、生育要求、随访条件、个人意愿及其它因素,严格规范随访,以防宫颈癌的发生发展。
Objective: To investigate the diagnostic and therapeutic value of loop electro-surgical excisional procedure (LEEP) in cervical intraepithelial neoplasia (CIN). Methods: A retrospective analysis of 597 cases of cervical intraepithelial neoplasia (CIN) treated from January 2008 to December 2009 was performed. Under the premise of fully informed, according to the principle of voluntary, divided into 65 cases of uterine resection group (control group) and 532 cases of LEEP group (treatment group). Results: No recurrence was found after operation in both groups, with no significant difference (P> 0.05). 597 cases of cervical intraepithelial neoplasia (CIN) patients preoperative and postoperative pathological examination coincidence rate: grade (consistent) 48.58%, 40.03% downgrade (postoperative pathological examination of chronic cervicitis accounted for 8.21%), an upgrade of 11.39%. LEEP after excision of cervical cancer positive margins in 27 cases, of which 13 cases underwent hysterectomy, 8 cases of second LEEP, the margin was negative after surgery, conservative follow-up of 6 cases, six months to one year average yin. Discussion: LEEP CIN safe and effective treatment, minimally invasive, fewer complications, at the same time in the diagnosis can be made to make up for colposcopy biopsy deficiencies. LEEP meets physiological requirements, treats the disease while preserving the genital integrity of the patient, preserves reproductive function in younger patients and does not affect pregnancy. Easy to operate, fast recovery rate is high, in outpatient surgery, without hospitalization, low cost, the patient is easy to accept. Patients with positive CINⅢ margin did not find persistence or recurrence of the lesion at follow-up. Therefore, LEEP or strict follow-up after LEEP pathology upgrade or positive margins exclusion should be performed to prevent over-treatment. As long as the strict follow-up, CIN Ⅲ conservative treatment of indications can be extended to positive margins patients, but under the premise of fully informed based on patient age, fertility requirements, follow-up conditions, personal wishes and other factors, strictly follow-up to prevent cervical The occurrence and development of cancer.