不同锥切术式在子宫颈高度鳞状上皮内病变中的应用比较

摘要

目的 评估三种不同锥切术式在子宫颈高级别鳞状上皮内病变(HSIL)中的临床疗效,进一步探讨切缘阳性和复发的高危因素.方法 回顾性分析216例HSIL患者的临床资料,根据术式分为冷刀组(CKC),电刀组(EKC)和环切组(LEEP),比较其临床疗效和并发症.结果 (1)HPV感染前三位的是16、58、52型,阴道镜下活检和锥切术后病理一致性中等;(2)三组手术时间和术中出血量两两比较差异均有统计学意义(P45岁、LEEP术式是切缘阳性/复发的高危因素.结论 LEEP和EKC治疗HSIL相对CKC均具有出血少、手术时间短的优点,但EKC在锥高、切缘阳性/复发率及高危HPV持续感染方面要优于LEEP.%Objective To?evaluate?the?clinical?efficacy?of?three?different?conization?methods?in?cervical?high-grade?squamous?intraepithelial?lesions?(HSIL),and?to?further?explore?the?high?risk?factors?of?positive?margin?and?recurrence.?Methods A?retrospective?case?series?analysis?was?performed?with?a?total?of?216?HSIL?patients?who?underwent?surgery?in?Zhejiang?Provincal?Hospital?of?TCM?between?March?2013?and?March?2015. Results (1) The?most?common?human?papilloma?virus(HPV)types?detected?in?follow?up?were?HPV16(28.48%),HPV58(17.88%),HPV52(9.6%).?Colposcopic?biopsy?and?pathology?after?conization?shew?moderate?consistency.(2)There?was?statistically?significant?difference?in?the?intraoperative?blood?loss?volume?and?the?operative?time?through?pairwise?comparison(P<0.05);(3)The?height?of?conization?sample?in?the?EKC?and?CKC?group?were?greater?than?that?in?the?LEEP?group,but?the?positive?margin?rate?or?postoperative?recurrent?rate?was?significantly?lower?LEEP(P<0.01);(4)The?high?risk?HPV?persistent?infection?rate?after?operation?in?the?EKC?or?CKC?group?was?lower?than?that?in?the?LEEP?group,the?difference?was?statistically?significant(P<0.01).(5)The?age,HPV?typing(type?16/18?vs.?Other?types)and?LEEP?were?significantly?related?with?positive?margin/recurrent.?Conclusions EKC?is?an?alternative?technique?for?diagnosis?and?treatment?of?HSIL?with?relatively?low?rate?of?positive?margin/recurrence?and?acceptable?rate?of?complications.