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目的:探讨宫颈环形电切术在治疗宫颈CINⅢ的临床价值。方法:对在阴道镜辅助下,多点活检病理证实为宫颈CINⅢ级的患者69例进行回顾性研究,其中38例行宫颈环形电切术(LEEP)治疗,另31例行冷刀锥切术,分别对其手术时间、术中出血情况、病灶残留情况、CIN复发情况、术后并发症进行比较。结果:LEEP组术后发现侵润癌2例,冷刀锥切组发现侵润癌1例,分别行手术治疗,其余各病例中,二者在手术时间、术中出血、术后出血中,LEEP组明显优于冷刀组,LEEP组术后病理边缘病灶残留(CINⅠ级)1例占2.7%。术后半年内治愈率LEEP组97.3%,冷刀组100%,两者无明显差异。LEEP组半年后再行LEEP活检术发现CINⅠ～Ⅱ级3例占8.1%,冷刀组半年后多点活检CINⅠ1例占3.3%。由于二者取材方法不同无法进行比较,冷刀组术后宫颈部分或全部粘连3例10%,LEEP组为1例占5.4%,二者术后1年均未见复发病例。结论:LEEP手术对于治疗宫颈CINⅢ级是行之有效的方法,但需要有一定的操作技术及完善的术后随访。
Objective: To investigate the clinical value of cervical circumcision in the treatment of cervical CIN Ⅲ. Methods: A retrospective study was performed on 69 patients with multi-point biopsy confirmed by cervical colposcopy assisted by colposcopy. Among them, 38 patients underwent LEEP and another 31 underwent cold knife conization , Respectively, the operation time, intraoperative bleeding, residual lesions, CIN recurrence, postoperative complications were compared. Results: Two cases of invasive carcinoma were found in LEEP group and one case of invasive carcinoma in cold-knife conization group. Surgical treatment was performed in each case. In the other cases, LEEP group was significantly better than the cold knife group, LEEP group postoperative pathological margins (CIN Ⅰ grade) in 1 case accounted for 2.7%. Within six months after surgery, the cure rate of LEEP group was 97.3% and cold knife group was 100%. There was no significant difference between the two groups. LEEP group six months later LEEP biopsy found CIN Ⅰ ~ Ⅱ grade 3 cases accounted for 8.1%, cold knife six months after multi-point biopsy CIN Ⅰ 1 cases accounted for 3.3%. Because of the difference between the two methods, 3 cases of partial or complete cervical adhesions in cold knife group were 10% and 1 case of LEEP group was 5.4%. No recurrence was found in 1 year postoperatively. Conclusion: LEEP is an effective method for the treatment of cervical CIN Ⅲ grade, but requires some operation techniques and perfect postoperative follow-up.