李海洋, 章波儿, 吕杰强. 海岛妇女LEEP治疗高级别宫颈上皮内瘤变168例临床分析[J]. 中国肿瘤临床, 2008, 35(20): 1161-1164.
引用本文: 李海洋, 章波儿, 吕杰强. 海岛妇女LEEP治疗高级别宫颈上皮内瘤变168例临床分析[J]. 中国肿瘤临床, 2008, 35(20): 1161-1164.
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LI Hai-yang, ZHANG Bo-er, LV Jie-qiang. Clinical Analysis of 168 Cases of Cervical Intraepithelial Neoplasia Ⅱ~Ⅲ Treated by Loop Electrosurgical Excision[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2008, 35(20): 1161-1164.
Citation: LI Hai-yang, ZHANG Bo-er, LV Jie-qiang. Clinical Analysis of 168 Cases of Cervical Intraepithelial Neoplasia Ⅱ~Ⅲ Treated by Loop Electrosurgical Excision[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2008, 35(20): 1161-1164.
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海岛妇女LEEP治疗高级别宫颈上皮内瘤变168例临床分析

Clinical Analysis of 168 Cases of Cervical Intraepithelial Neoplasia Ⅱ~Ⅲ Treated by Loop Electrosurgical Excision

    摘要
  • 摘要: 目的: 探讨宫颈上皮内瘤样病变(CIN)Ⅱ～Ⅲ宫颈环形电刀切除术(LEEP)治疗的有效性。 方法: 回顾分析浙江省舟山市妇幼保健院2002年6月至2007年9月因CINⅡ～Ⅲ行LEEP手术的168例患者临床资料,对手术前后病理、术后患者的治愈率、病变持续存在及复发等情况进行分析总结。 结果: 手术前后病理诊断符合率64.3%(108/168),升级占12.5%(21/168),降级占23.2%(39/168)。剔除LEEP术后切缘阳性或宫颈癌再次手术者19例,接受6～69个月随访者149例,总治愈率96.0%(143/149),病变持续存在率4.0%(6/149),复发率12.1%(18/149)。LEEP术后CINⅡ41例,6个月治愈率95.1%(39/41),病变持续存在率4.9%(2/41),1年复发率为7.3%(3/41),2年复发率为7.3%(3/41);CINⅢ81例,6个月治愈率95.1%(77/81),病变持续存在率4.9%(4/81),1年复发率为6.2%(5/81),2年复发率为7.4%(6/81),3、4、5年均无复发。CINⅡ、CINⅢ在治愈率、病变持续存在率、复发率方面比较差异无显著性(P=0.963)。LEEP术后病理切缘阳性者、阴性者复发率分别为33.3%(3/9)、10.7%(15/140),两者比较差异无显著意义(P=0.065);病变持续存在率分别为22.2%(2/9)、2.9%(4/140),两者比较差异有显著意义(P=0.040)。病变持续存在与术后病理切缘是否受累有关,与病变级别无关。 结论: 对于阴道镜下点状活检诊断为CINⅡ～Ⅲ适宜行LEEP,不仅达到治疗目的,而且能进一步明确宫颈病变程度,但术后应密切随访,尤其术后前2年。

     

    Abstract: Objective : To determine the effect of the loop electrosurgical excision procedure (LEEP) on cervical in-traepithelial neoplasia (CIN) Ⅱ~Ⅲ. Methods : Records of 168 CIN Ⅱ~Ⅲ cases treated with LEEP betweenJune 2002 and September 2007 were retrospectively reviewed. The cure rate, pre- and postoperative histolo-gy, disease persistence and recurrence rate were analyzed. Results : The coincidence rate of multiple biopsiesand LEEP conization was 64.3% (108/168). About 12.5% (21/168) of the cases were upgraded while 23.2%(39/168) were downgraded after LEEP conization. Nineteen patients with positive margins or cervical carcino-ma were rejected and offered other surgical procedures. The other 149 patients of CIN Ⅱ~Ⅲ treated withLEEP were followed up for 6~69 months. The overall cure rate was 96.0% (143/149) at 6 month after LEEP.Persistence was identified in 4.0% (6/149) of the patients, and recurrence was seen in 12.1% (18/149) of thecases. For the 41 CIN Ⅱ cases, the overall cure rate was 95.1% at 6 months after LEEP, and the rate of dis-ease persistence was 4.9% (2/41). Recurrence occurred in 7.3% (3/41) of the patients in the first year and7.3% (3/41) in the second year. For the 81 cases of CIN Ⅲ, the overall cure rate was 95.1% (77/81) at 6months after LEEP and the rate of disease persistence was 4.9% (4/81). Recurrence rate was 6.2% (5/81) inthe first year, 7.4% (6/81) in the second year, and 0% in the third year. No statistical significance was foundbetween CIN Ⅱ cases and CIN Ⅲ cases (P=0.963). The recurrence rate was 33.3% (3/9) in 9 patients withpositive conization margins and 10.7% (15/140) in the 140 cases with negative margins. No significant differ-ence was found between the two groups (P=0.065). The rate of persistence was 22.2% (2/9) in the cases withpositive margins and 2.9% (4/140) in the cases with negative margins, with a significant difference betweenthe 2 groups (P=0.040). There may be a positive correlation between disease persistence and positive mar-gins. Conclusion : LEEP is a suitable procedure for CIN Ⅱ~Ⅲ cases, both diagnostically and therapeutically.Close follow-up is needed, especially during the first two years after the procedure.

     

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