改良冷刀锥切术与环形电切术治疗宫颈高级别内皮瘤临床疗效及预后影响因素分析

摘要

目的：探讨使用改良冷刀锥切术(CKC)治疗宫颈高级别内皮瘤(CINⅡ～Ⅲ)的疗效观察和对预后影响的因素。方法：采用随机数表法选取189例CINⅡ～Ⅲ患者，按治疗方法的不同将其分为观察组(106例)与对照组(83例)，观察组采用改良CKC切除术治疗，对照组采用高频电波刀宫颈环形电切术(LEEP)治疗，观察分析两组的疗效及预后的影响。结果：两组患者在手术时间、术中出血量和视觉模拟评分(VAS)等手术情况进行比较，均无差异(t=0.034，t=0.093，t=0.104；P＞0.05)；术后切缘病变残留率和诊断符合率的病理结果两组比较有显著差异(x2=4.516， x2=10.013；P＜0.05)；住院时间、术后阴道溢液时间和愈合时间等恢复情况两组比较有显著差异(t=0.017，t=0.014，t=0.003；P＜0.05)；术后出血率、感染率、1年内并发症率和复发率两组比较有显著差异(x2=0.041，x2=0.048，x2=0.047，x2=0.042；P＜0.05)。结论：使用改良CKC治疗宫颈CINⅡ～Ⅲ，操作简便、安全有效，能显著加快术后恢复，减少病灶残留，提高诊断符合率，减少术后并发症和复发率，是一种疗效较好的治疗方法。%Objective: To investigate the curative effect of modified cold knife cutting (CKC) in the treatment of cervical high grade CIN (II) and its prognostic factors. Methods: 126 cases of CIN II to III were selected and divided into observation group (106 cases) and control group (83 cases) according to different treatment methods. Modified CKC resection was used in the observation group and the control group used high frequency cervical loop electrosurgical excision procedure (LEEP) resection to observe the curative effect of the two groups and analyze the influence on the prognosis. Results: Compared the two groups of patients in operation time, intraoperative blood loss and visual analogue scale(VAS) and other operation conditions, the difference was not statistically significant(t=0.034, t=0.093, t=0.104; P>0.05). The difference was statistically significant about the urgical margin of residual lesion rate and diagnosis rate of the pathological results of the two groups (x2=4.516, x2=10.013; P<0.05). Hospital stay, postoperative vaginal discharge time and healing time were compared between the two groups, and the difference was statistically significant(t=0.017, t=0.014, t=0.003; P<0.05). The difference was statistically significant about the postoperative bleeding rate, infection rate, and complication rate and recurrence rate within 1 year (x2=0.041, x2=0.048, x2=0.047, x2=0.042; P<0.05). Conclusion: The method of cervical high-level endothelial tumor treated by improved cold knife conization is safe, effective and simple. It can significantly accelerate the postoperative recovery, reduce the lesion residue, improve the diagnostic coincidence rate, as well as reduce the postoperative complications and recurrence rate, so it is an ideal treatment method.