宫颈锥切术在子宫颈病变诊治中的应用

摘要

目的:比较宫颈锥切术包括电圈切除术(LEEP)和冷刀锥切术(CKC)治疗宫颈病变的效果,分析宫颈病变持续或复发的影响因素.方法:按三阶梯技术筛查,选择有手术指征的宫颈病变患者596例.其中LEEP术组490例,CKC术组106例.比较2组的手术时间、出血量、人乳头瘤病毒(HPV)清除率、切缘阳性率、病变持续或复发率;分析LEEP的病理可判断性及病变持续或复发的影响因素.结果:LEEP组和CKC组手术时间、出血量、术后6个月HR-HPV清除率、切缘阳性率、病变持续及复发率间均存在显著性差异(均P<0.05).LEEP术病理标本烧灼严重无法辨认切缘的发生率2.96%(15/507).病变程度高、切缘阳性、标本多象限受累、HPV持续阳性与病变持续或复发率增高均显著相关(均P<0.01).随访HPV转阴的患者,即使切缘阳性也有病变消失者;HR-HPV持续阳性的患者,切缘阴性也有病变持续或复发.结论:LEEP术与CKC术比较,手术时间短、出血量少、HPV清除率低、切缘阳性率高、病变持续或复发率高.病变程度高、标本多象限受累、HPV持续、切缘阳性,可导致病变持续或复发率增高.%Objective:To compare the effects of different methods of conization and to analyze influence factors of persistence or recurrence of lesions.Methods:A total of 596 patients were screened with"three-step"technique for cervical intraepithelial neoplasia (CIN).Of them,490 cases were in loop electrosurgical excision procedure (LEEP)group and 106 in cold knife conization (CKC)group.Operating time,blood loss,clearance of HPV,status of incisal margins,rate of persistence or recurrence were compared between the two groups respectively.Cauterization effect on pathology judgement and influence factors of lesions persistence or recurrence were analyzed.Results:There were significant differences between the LEEP group and CKC group in the operating time,the blood loss,the clearance rate of HPV 6 months after operation,the positive rate of incisal margins,the persistence or recurrence rate of lesions(all P＜0.05).Among specimens of LEEP the rate of serious cauterization affecting the judgement of incisal margins was 2.96％(15/507).The rate was high in the patients whose lesions had high grade CIN,positive incisal margins,multi quadrants involved,HPV persistent positive.Those might be cured whose HPV turned into positive even incisal margins positive,and those lesions might be persisted or recurrented who were persistently infected by HPV even incisal margins negative.Conclusion:Compared with CKC group,the LEEP group was associated with shorter operating time,less blood loss,lower rate of HPV clearance,higher positive rate of incisal margins,higher persistence or recurrence of lesions,whereas the rate of persistence or recurrence was high in the patients whose lesions had the characters of high grade CIN,positive incisai margins,multi quadrants involved,HPV persistent positive.