Loop electrosurgical excision procedue: a valuable method for the treatment of cervical intraepithelial neoplasia
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF OBSTETRICS AND GYNECOLOGY
- Issue:
- 5
- DOI:
- 10.3760/j.issn:0529-567X.2001.05.004
- Key Word:
- 电外科手术;宫颈上皮内瘤样病变;手术中并发症;肿瘤复发,局部
Abstract： 目的探讨宫颈环形电切术(LEEP)治疗官颈上皮内瘤变(CIN)的效果以及宫颈标本边缘受累与否与预后的关系.方法采用阴道镜辅助下的宫颈环形电切术,对135例CIN患者进行治疗并对其疗效进行回顾性分析.结果本研究中,患者中位年龄为42岁(18～67岁),中位妊娠次数2.2次(0～8次).根据宫颈细胞学涂片检查结果,诊断为重度鳞状上皮内瘤变(HGSIL)占65.9%,阴道镜诊断亦与上述结果类似(75.6%).LEEP术后病理检查结果阴性者7例(5.2%);人乳头状瘤病毒(HPV)感染者2例(1.5%);CINⅠ级(CINⅠ)15例(11.1%);HGSIL 108例(80.0%),其中CINⅡ级(CINⅡ)20例(14.8%),CINⅢ级(CINⅢ)88例(65.2%);宫颈微小浸润癌3例(2.2%).78例(57.8%)宫颈标本边缘病理学检查未见CIN病变;57例(42.2%)宫颈标本边缘CIN病变检测阳性或不能确定(指由于电灼对细胞的破坏,影响了LEEP术后标本边缘的病理诊断),其中HGSIL54例(94.7%).在21例(15.6%)宫颈标本边缘CIN病变检测阳性和36例(26.7%)宫颈标本边缘病理学检查不能确定患者中,CIN病变残留患者分别为1例(4.8%)和3例(8.3%),复发患者分别为1例(4.8%)和2例(5.6%);而在78例宫颈标本边缘无CIN病变累及患者中,仅发现CIN病变残留患者2例(2.6%),此类患者术后复发率为0.0%(0/78).135例中,首次LEEP术后治愈126例(93.3%);6例(4.4%)患者发现残留CIN病变,3例(2.2%)患者出现术后复发;19例(14.1%)患者出现术中、术后并发症.结论LEEP是治疗CIN的一种安全有效的方法.但术后应特别注意标本边缘的病理检查结果,宫颈标本边缘受累与否是病变残留和复发的高危因素.
- [1]Ferenczy A,Choukroun D,Arseneau J.Loop electrosurgical excision procedure for squamous intraepithelial lesions of the cervix: advantages and potential pitfalls.[J].1996,87(3).
- [2]A C, Crompton,N, Johnson.Which is more painful? A randomized trial comparing loop with laser excision of the cervical transformation zone.[J].1994,52(3).
- [3]W.R. Robinson,J.S. Tirpack.The predictive value of LEEP specimens with involved margins for residual dysplasia[J].1996,6(2).
- [4]Thomas J. Herzog,Sybilann Williams,Lisa M. Adler,etc.Potential of Cervical Electrosurgical Excision Procedure for Diagnosis and Treatment of Cervical Intraepithelial Neoplasia[J].1995,57(3).
- [5]M J, Messing,L, Otken,L A, King,etc.Large loop excision of the transformation zone (LLETZ): a pathologic evaluation.[J].1994,52(2).
- [6]WALTER PRENDIVILLE,JOHN CULLIMORE,SUE NORMAN.Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia[J].1989,96(9).
- [7]O A, Oyesanya,C, Amerasinghe,E A, Manning.A comparison between loop diathermy conization and cold-knife conization for management of cervical dysplasia associated with unsatisfactory colposcopy.[J].1993,50(1).