阴道镜联合利普(LEEP)刀治疗宫颈癌变的可行性及安全性分析
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摘要
目的探讨阴道镜联合LEEP刀治疗CIN的可行性及安全性。方法将83例CIN患者随机分为观察组(n=42)和对照组(n=41)。所有患者均给予阴道镜评估病变,观察组给予LEEP治疗,对照组常规手术治疗。观察阴道镜活检与LEEP术切除结果符合率,比较2组临床疗效、手术基本情况、术后6个月复发转移情况及生活质量改善情况。结果阴道镜活检与LEEP术后病理活检诊断符合率92.86%,二者诊断HSIL(95.83%)的符合率高于LSIL(88.89%)。观察组术中出血量少于对照组(t=-13.960,P=0.000),手术时间低于对照组(t=-17.456,P=0.000),临床有效率(97.62%)高于对照组(85.37%)(Z=-2.595,P=0.009),远期复发率(4.76%)显著低于对照组的(43.90%)(χ~2=17.378,P=0.000),生活质量改善率(30.95%)高于对照组的(19.51%)(Z=-2.673,P=0.008)。结论阴道镜联合LEEP治疗CIN临床疗效显著,诊断符合率高,可有效减少术中出血量,缩短手术时间,降低复发率,安全性高,能够有效改善患者生存质量,值得推广。
Objective To investigate the feasibility and safety of colposcopy combined with LEEP in the treatment of cervical cancer. Methods 80 patients with cervical cancer were randomly divided into the observation group( n = 42) and the control group( n = 41). All patients were given colposcopy to assess the lesion,the observation group received LEEP treatment,the control group received conventional surgical treatment. The coincidence rate of colposcopy biopsy and LEEP resection were observed,the clinical efficacy,the basic operation,6-month recurrence and metastasis rates and the improvement of quality of life were compared. Results The coincidence rate of colposcopy biopsy was 92. 86% compared with LEEP,and the coincidence rate of HSIL( 95. 83%) was higher than that of LSIL( 88. 89%).( 13. 68 ± 2. 31) ml in the observation group was lower than that of the control group( 43. 23 ± 14. 29) ml( t =-13. 960,P = 0. 000). The operation time( 6. 23 ± 0. 75) min was lower than that of the control group( 39. 17 ± 12. 06)( 95. 97%)( Z =-2. 595,P = 0. 009),and the long-term recurrence rate( 4. 76%) was significantly lower than that of the control group( 97. 62%)( P < 0. 05)( 43. 90%),( χ~2= 17. 378,P = 0. 000),and the improvement rate of quality of life( 30. 95%) was higher than that of the control group( 19. 51%)( Z =-2. 673,P = 0. 008).Conclusion Colposcopy combined with LEEP is effective in the treatment of cervical cancer,and the diagnostic accuracy is high,which can effectively reduce the intraoperative blood loss,shorten the operation time,reduce the recurrence rate with high safety,and can effectively improve the quality of life of patients.
Objective To investigate the feasibility and safety of colposcopy combined with LEEP in the treatment of cervical cancer. Methods 80 patients with cervical cancer were randomly divided into the observation group( n = 42) and the control group( n = 41). All patients were given colposcopy to assess the lesion,the observation group received LEEP treatment,the control group received conventional surgical treatment. The coincidence rate of colposcopy biopsy and LEEP resection were observed,the clinical efficacy,the basic operation,6-month recurrence and metastasis rates and the improvement of quality of life were compared. Results The coincidence rate of colposcopy biopsy was 92. 86% compared with LEEP,and the coincidence rate of HSIL( 95. 83%) was higher than that of LSIL( 88. 89%).( 13. 68 ± 2. 31) ml in the observation group was lower than that of the control group( 43. 23 ± 14. 29) ml( t =-13. 960,P = 0. 000). The operation time( 6. 23 ± 0. 75) min was lower than that of the control group( 39. 17 ± 12. 06)( 95. 97%)( Z =-2. 595,P = 0. 009),and the long-term recurrence rate( 4. 76%) was significantly lower than that of the control group( 97. 62%)( P < 0. 05)( 43. 90%),( χ~2= 17. 378,P = 0. 000),and the improvement rate of quality of life( 30. 95%) was higher than that of the control group( 19. 51%)( Z =-2. 673,P = 0. 008).Conclusion Colposcopy combined with LEEP is effective in the treatment of cervical cancer,and the diagnostic accuracy is high,which can effectively reduce the intraoperative blood loss,shorten the operation time,reduce the recurrence rate with high safety,and can effectively improve the quality of life of patients.
引文
[1]范志刚.中晚期宫颈癌同步放化疗临床研究进展[J].实用癌症杂志,2012,27(3):309.
[2]贾芸.宫保散联合LEEP治疗宫颈癌前病变并发HPV感染的疗效观察[J].中国妇幼保健,2015,30(19):3307-3309.
[3]阎立爽,陈艳鸿,阎金凤.宫颈电圈切除术(LEEP)治疗慢性宫颈炎368例疗效分析[J].中国妇科临床杂志,2012,7(1):44-46.
[4]劳芝英.HPV、TCT及阴道镜对宫颈癌筛查的意义[J].实用癌症杂志,2014,29(7):826-830.
[5]朱燕宁.子宫颈上皮内瘤变的病理学诊断[J].中华妇产科杂志,1996,31(1):58-60.
[6]Kim MK,Kim MA,Kim JW,et al.Loop electrosurgical excision procedure findings for identification of patients with early-stage cervical cancer suitable for less radical surgery[J].Int J Gynecol Cancer,2012,22(7):1214-1219.
[7]乔志强,李隆玉,张敏芳,等.多种检测方法在子宫颈癌及癌前病变筛查中的应用评估[J].中华流行病学杂志,2007,28(10):964-967.
[8]谢珊艳,任鹏,吕晨君.TCT,HC2-HPV-DNA检测和阴道镜检查在宫颈癌及癌前病变筛查中的联合应用[J].中国性科学,2014,23(3):82-84.
[9]徐水芳,徐凤英,王桂芳,等.LEEP术后病理检查与阴道镜宫颈活检对宫颈癌前病变的诊断准确性[J].实用癌症杂志,2013,28(3):269-272.
[10]龚洪春,毕红.阴道镜下活检在宫颈癌前病变筛查中的临床应用[J].中国妇幼保健,2016,31(16):3394-3396.
[11]曹旭,吴文芳,姚小艳,等.LEEP诊断治疗宫颈上皮内瘤变临床分析[J].中华全科医学,2012,10(4):547.
[12]李琦,胡昌华,倪铭.宫颈上皮内瘤变患者阴道镜多点活检和LEEP术后组织病理学分级结果比较研究[J].实用癌症杂志,2015,30(12):1902-1905.
[13]周俏苗,陈建林.LEEP术治疗宫颈癌前病变对产妇妊娠结局的影响研究[J].实用癌症杂志,2015,30(5):679-681.
[14]毕雪玲.LEEP治疗宫颈上皮内瘤变的临床疗效及高危型HPV检测在术后随访中的价值[J].实用癌症杂志,2013,28(4):417-419.
[15]牡丹,宋志华.LEEP治疗宫颈癌前病变临床观察[J].疾病监测与控制杂志,2013,7(1):55-56.
[2]贾芸.宫保散联合LEEP治疗宫颈癌前病变并发HPV感染的疗效观察[J].中国妇幼保健,2015,30(19):3307-3309.
[3]阎立爽,陈艳鸿,阎金凤.宫颈电圈切除术(LEEP)治疗慢性宫颈炎368例疗效分析[J].中国妇科临床杂志,2012,7(1):44-46.
[4]劳芝英.HPV、TCT及阴道镜对宫颈癌筛查的意义[J].实用癌症杂志,2014,29(7):826-830.
[5]朱燕宁.子宫颈上皮内瘤变的病理学诊断[J].中华妇产科杂志,1996,31(1):58-60.
[6]Kim MK,Kim MA,Kim JW,et al.Loop electrosurgical excision procedure findings for identification of patients with early-stage cervical cancer suitable for less radical surgery[J].Int J Gynecol Cancer,2012,22(7):1214-1219.
[7]乔志强,李隆玉,张敏芳,等.多种检测方法在子宫颈癌及癌前病变筛查中的应用评估[J].中华流行病学杂志,2007,28(10):964-967.
[8]谢珊艳,任鹏,吕晨君.TCT,HC2-HPV-DNA检测和阴道镜检查在宫颈癌及癌前病变筛查中的联合应用[J].中国性科学,2014,23(3):82-84.
[9]徐水芳,徐凤英,王桂芳,等.LEEP术后病理检查与阴道镜宫颈活检对宫颈癌前病变的诊断准确性[J].实用癌症杂志,2013,28(3):269-272.
[10]龚洪春,毕红.阴道镜下活检在宫颈癌前病变筛查中的临床应用[J].中国妇幼保健,2016,31(16):3394-3396.
[11]曹旭,吴文芳,姚小艳,等.LEEP诊断治疗宫颈上皮内瘤变临床分析[J].中华全科医学,2012,10(4):547.
[12]李琦,胡昌华,倪铭.宫颈上皮内瘤变患者阴道镜多点活检和LEEP术后组织病理学分级结果比较研究[J].实用癌症杂志,2015,30(12):1902-1905.
[13]周俏苗,陈建林.LEEP术治疗宫颈癌前病变对产妇妊娠结局的影响研究[J].实用癌症杂志,2015,30(5):679-681.
[14]毕雪玲.LEEP治疗宫颈上皮内瘤变的临床疗效及高危型HPV检测在术后随访中的价值[J].实用癌症杂志,2013,28(4):417-419.
[15]牡丹,宋志华.LEEP治疗宫颈癌前病变临床观察[J].疾病监测与控制杂志,2013,7(1):55-56.