宫颈环形电切术诊治宫颈上皮内瘤变价值的研究(1)
【摘要】 目的 探讨使用高频电波刀作宫颈环形电切术(LEEP)治疗宫颈上皮内瘤变(CIN)的临床价值。方法 经宫颈液基薄片细胞学检查(TCT)和 阴道镜下活检，病理诊断为CIN 232例，行LEEP治疗。术后3个月、6个月~2年常规行TCT追踪随访，异常者再行阴道镜检查及活检。结果 术后3个月复查232例，TCT正常者220例(94.83%)，异常者12例(5.17%)，阴道镜检查宫颈表面出现红斑，活检均为炎性反应或正常宫颈组织；术后6个月复查228例,TCT正常者222例(97.37%)，异常者4例(2.63%)，阴道镜检查及活检均为炎性反应；术后2年复查172例,TCT阴性170例(98.84%)，异常者2例(1.16%)，阴道镜检查及活检1例为炎性反应，1例为CINⅠ。结论 宫颈环形电切术治疗宫颈上皮内瘤样病变操作简单、安全、成功率高，但要注意病变切除的范围及随访，宫颈环行电切除是治疗CIN有效手段。
【关键词】 宫颈环形电切术；宫颈上皮内瘤样病变；宫颈液基薄片细胞学检查
, 百拇医药
The research of loop electrosurgical excision procedure for cervical intraepithelial neoplasia
WU Cai-qin，YANG Xue-feng.Zhengzhou University School of Medicine Basic,Luohe,Henan 462000,China
【Abstract】 Objective To evaluate the loop electrosurgical excision procedure (LEEP)in thetreatmentofcervicalintraep-ithelial neoplasia (CIN).Methods 232 patients with CIN diagnosed by cervix liquor tabular cell test(TCT) and biopsy through vaginoscope were operated on by:LEEP,they were follow-up visited by TCT after three months,six months and two years.,those abnormality were re-checked by vaginoscopy and biopsy.Results Among 232 cases who were re-checked three months after operation,220 patients(94.83%)showed normal appearance,the other 12 cases(5.17%) showed obnormal appearance,cervix uteri surface emerged erythemathrough colposcopy examination,they were confirmed inflammation or normal cervical tissue; Six months after operation,228 patients were re-checked,222 patients(97.37%)showed normal appearance by TCT,four patients(2.63%)showed abnormal appearance,they were all confirmed inflammation by colposcopy examination and biopsy;Two years after operation 172 patients were re-checked,170 patients(98.84%)showed normal appearance,two cases(1.16%)showed abnormal appearance by colposcopy examination and biopsy it was confirmed that one case was inflammation,the other was CINⅠ.Conclusion It is simple,safe and high success ratio to cure CIN by LEEP,but the cut range shuld be attentioned.LEEP is an effective method in curing CIN.
, 百拇医药
【Key words】
Loop electrosurgical excision procedure(LEEP);Cervical intraepithelial neoplasia(CIN);Cervix liquor tabular cell test(TCT)
子宫颈癌是常见的妇科肿瘤之一，发病率占女性生殖系统恶性肿瘤之首[1]，宫颈癌前病变-宫颈上皮内瘤变(CIN)，具有双相发展的特性，其中一部分向宫颈癌演变、发展，是个较长时间的过程，故去除病灶是阻断宫颈癌发生的重要环节。CIN常用的治疗方法有高频电波刀环形切除术(LEEP术)、宫颈锥形切除术、子宫切除术等，过去CINⅡ、CINⅢ大多采用子宫切除术，使大多年轻患者丧失了生育功能。LEEP术是近几年发展起来的一种新技术，此方法采用低电压、高电流以及细小的环型电刀切除宫颈病变，治疗的同时可提供标本进行病理学检查，获得更精确的诊断。操作简单、易行，是诊治宫颈疾病安全有效的方法[2]。自2006年8月至2008年12月 对232例CIN患者进行LEEP术治疗，效果满意。
, 百拇医药
1 资料和方法
1.1 一般资料 选自本院门诊及郑州大学第三附属医院门诊经妇科检查、宫颈液基薄片细胞学检查(TCT)、阴道镜及宫颈活检初步诊断CIN病例共232例。年龄19~70岁，平均34.8岁。未绝经者224例，绝经者8例。平均孕次3.34次，平均产次2.08次，其中从未妊娠者13例。宫颈病变诊断情况：CINⅠ级87例、CINⅡ 110例、CINⅢ 35例。
1.2 方法 全部病例均经阴道镜检查及镜下定点活检，病理学检查诊断为CIN后行 LEEP术治疗。手术时间：月经干净3~7 d。LEEP术前宫颈敷3%醋酸棉球和卢格碘溶液(碘试验)，再次确定病变范围，在病变范围边缘外5 mm处进出电极，以三角形电极顺时针旋转切除宫颈管组织15~20 mm，宫颈组织厚度6~7 mm，如病变范围较大，再补以环形电极扩大切除宫颈组织。切除标本全部行病理组织学诊断。
1.3 术后随诊 术后1周、1个月复诊，了解阴道出血、分泌物及宫颈创面修复情况等，如异常增加复诊次数；术后3个月，全部病例行TCT检查，如TCT发现异常行阴道镜检查及活检，TCT检查3次正常后改为每半年随访1次；术后2年TCT检查正常者以后每年一次。
2 结果
2.1 阴道镜下定点活检与LEEP术后病理结果比较 232例患者阴道镜检查及镜下定点活检病理情况与LEEP术后标本病理诊断比较见表1。
, 百拇医药(吴彩琴 杨雪峰)
【关键词】 宫颈环形电切术；宫颈上皮内瘤样病变；宫颈液基薄片细胞学检查
, 百拇医药
The research of loop electrosurgical excision procedure for cervical intraepithelial neoplasia
WU Cai-qin，YANG Xue-feng.Zhengzhou University School of Medicine Basic,Luohe,Henan 462000,China
【Abstract】 Objective To evaluate the loop electrosurgical excision procedure (LEEP)in thetreatmentofcervicalintraep-ithelial neoplasia (CIN).Methods 232 patients with CIN diagnosed by cervix liquor tabular cell test(TCT) and biopsy through vaginoscope were operated on by:LEEP,they were follow-up visited by TCT after three months,six months and two years.,those abnormality were re-checked by vaginoscopy and biopsy.Results Among 232 cases who were re-checked three months after operation,220 patients(94.83%)showed normal appearance,the other 12 cases(5.17%) showed obnormal appearance,cervix uteri surface emerged erythemathrough colposcopy examination,they were confirmed inflammation or normal cervical tissue; Six months after operation,228 patients were re-checked,222 patients(97.37%)showed normal appearance by TCT,four patients(2.63%)showed abnormal appearance,they were all confirmed inflammation by colposcopy examination and biopsy;Two years after operation 172 patients were re-checked,170 patients(98.84%)showed normal appearance,two cases(1.16%)showed abnormal appearance by colposcopy examination and biopsy it was confirmed that one case was inflammation,the other was CINⅠ.Conclusion It is simple,safe and high success ratio to cure CIN by LEEP,but the cut range shuld be attentioned.LEEP is an effective method in curing CIN.
, 百拇医药
【Key words】
Loop electrosurgical excision procedure(LEEP);Cervical intraepithelial neoplasia(CIN);Cervix liquor tabular cell test(TCT)
子宫颈癌是常见的妇科肿瘤之一，发病率占女性生殖系统恶性肿瘤之首[1]，宫颈癌前病变-宫颈上皮内瘤变(CIN)，具有双相发展的特性，其中一部分向宫颈癌演变、发展，是个较长时间的过程，故去除病灶是阻断宫颈癌发生的重要环节。CIN常用的治疗方法有高频电波刀环形切除术(LEEP术)、宫颈锥形切除术、子宫切除术等，过去CINⅡ、CINⅢ大多采用子宫切除术，使大多年轻患者丧失了生育功能。LEEP术是近几年发展起来的一种新技术，此方法采用低电压、高电流以及细小的环型电刀切除宫颈病变，治疗的同时可提供标本进行病理学检查，获得更精确的诊断。操作简单、易行，是诊治宫颈疾病安全有效的方法[2]。自2006年8月至2008年12月 对232例CIN患者进行LEEP术治疗，效果满意。
, 百拇医药
1 资料和方法
1.1 一般资料 选自本院门诊及郑州大学第三附属医院门诊经妇科检查、宫颈液基薄片细胞学检查(TCT)、阴道镜及宫颈活检初步诊断CIN病例共232例。年龄19~70岁，平均34.8岁。未绝经者224例，绝经者8例。平均孕次3.34次，平均产次2.08次，其中从未妊娠者13例。宫颈病变诊断情况：CINⅠ级87例、CINⅡ 110例、CINⅢ 35例。
1.2 方法 全部病例均经阴道镜检查及镜下定点活检，病理学检查诊断为CIN后行 LEEP术治疗。手术时间：月经干净3~7 d。LEEP术前宫颈敷3%醋酸棉球和卢格碘溶液(碘试验)，再次确定病变范围，在病变范围边缘外5 mm处进出电极，以三角形电极顺时针旋转切除宫颈管组织15~20 mm，宫颈组织厚度6~7 mm，如病变范围较大，再补以环形电极扩大切除宫颈组织。切除标本全部行病理组织学诊断。
1.3 术后随诊 术后1周、1个月复诊，了解阴道出血、分泌物及宫颈创面修复情况等，如异常增加复诊次数；术后3个月，全部病例行TCT检查，如TCT发现异常行阴道镜检查及活检，TCT检查3次正常后改为每半年随访1次；术后2年TCT检查正常者以后每年一次。
2 结果
2.1 阴道镜下定点活检与LEEP术后病理结果比较 232例患者阴道镜检查及镜下定点活检病理情况与LEEP术后标本病理诊断比较见表1。
, 百拇医药(吴彩琴 杨雪峰)