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目的:探讨LEEP刀环切术对宫颈上皮内瘤样病变(CIN)的诊疗价值。方法:回顾性分析2007年1月～2009年8月舟山市妇幼保健院宫颈疾病门诊经阴道镜活检诊断为CIN的314例海岛妇女,均行LEEP刀宫颈环切术,观察患者术中情况、术后创面愈合、术前术后病理结果以及预后随访情况。结果:①手术时间:5～25 min,平均出血量13.8 ml(4～50 ml),根据病变范围,切除的宽度为1.0 cm～3.7 cm,平均2.5 cm。深度为1.5 cm～2.5 cm,平均1.6 cm。②术后宫颈创面均在2个月内愈合,多数宫颈光滑、圆润。③术前、术后宫颈环切组织病理结果比较,病理诊断相符189例,占60.2%;级别上升43例,占13.6%,其中4例术前CINⅠ而术后为CINⅢ,有9例CINⅢ术后病理证实为早期浸润癌;级别下降72例,占22.9%。21例患者标本切缘累及病灶,占6.7%,6例行重复LEEP术,11例行子宫切除术。④术后所有患者均定期随访,随访时间截至2010年3月,随访6～36个月。对于标本切缘未累及病灶的293例患者LEEP术的总治愈率为96.9%。CINⅡ和CINⅢ切缘阳性的病变残留率为19.0%。结论:LEEP宫颈环切术不但可以安全有效地治疗CIN,而且还可以评估阴道镜的诊断,减少高度病变的漏诊,而对于随访困难的一部分低级别海岛妇女患者也适合采用LEEP术治疗。
Objective: To investigate the value of LEEP circumcision in the diagnosis and treatment of cervical intraepithelial neoplasia (CIN). Methods: A retrospective analysis of 314 island women diagnosed as CIN by colposcopy biopsy of Zhoushan MCH hospital from January 2007 to August 2009 was performed cervical circumcision by LEEP knife. The intraoperative situation, Postoperative wound healing, preoperative and postoperative pathological results and follow-up of prognosis. Results: ① The operation time ranged from 5 to 25 minutes with an average blood loss of 13.8 ml (4 to 50 ml). The width of the resection ranged from 1.0 cm to 3.7 cm with an average of 2.5 cm. The depth of 1.5 cm ~ 2.5 cm, an average of 1.6 cm. ② postoperative cervical wound healing in 2 months, most of the cervix smooth, rounded. ③The histopathological results of preoperative and postoperative cervical circumcision were consistent with those of pathological diagnosis in 189 cases (60.2%); the grade increased in 43 cases (13.6%), including 4 cases of preoperative CINⅠ and postoperative CINⅢ and 9 cases of CINⅢ Pathology confirmed early invasive carcinoma; grade decreased 72 cases, accounting for 22.9%. Twenty-one of the 21 patients had lesions involving lesions, accounting for 6.7%. Six patients underwent LEEP and 11 underwent hysterectomy. ④ All patients were followed up regularly. The follow-up time was up to March 2010 and was followed up for 6 to 36 months. The total cure rate of LEEP was 96.9% in 293 patients with no lesion on the resected margin. CIN Ⅱ and CIN Ⅲ margin positive lesions retained rate of 19.0%. Conclusion: LEEP cervical circumcision can not only treat CIN safely and effectively, but also evaluate the diagnosis of colposcopy and reduce the misdiagnosis of high grade lesion. LEEP is also suitable for some low - grade island women with difficult follow - up.