LEEP与CKC治疗宫颈高级别上皮内瘤变的临床疗效比较
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摘要
目的比较宫颈环形电切术(LEEP)和宫颈冷刀锥切术(CKC)治疗宫颈高级别上皮内瘤变(HSIL)的临床疗效,探讨两种不同术式的优劣性。方法收集2015年1月1日至2017年12月31日广州医科大学附属第三医院收治的131例HSIL患者的临床资料,并以LEEP术和CKC术分组,统计分析比较两组手术时间、出血量、术后治愈率、病灶残留率、复发率、并发症发生率、术后妊娠率及妊娠结局。结果 LEEP组的手术时间为(5.71±1.38)min,少于CKC组的(32.25±14.35)min,差异有统计学意义(P<0.05);LEEP组的术中出血量为(3.57±1.51)mL,少于CKC组的(18.12±9.23)mL,差异有统计学意义(P<0.05)。LEEP组切缘阳性率为27.3%,高于CKC组(11.5%),差异有统计学意义(P<0.05),但两组治愈率(86.4%vs. 90.8%)、病灶残留率(7.1%vs. 5.1%)、复发率(2.6%vs. 0.0%)相比,差异均无统计学意义(P>0.05)。LEEP组术后并发症发生率为2.4%,低于CKC组(13.9%),差异无统计学意义(P>0.05)。两组术后妊娠率、妊娠结局比较,差异无统计学意义(P>0.05)。结论 LEEP治疗效果与CKC相当,但LEEP有手术时间短,术中出血少等优势。对于HSIL的治疗,应首选LEEP。
Objective To compare the clinical effect of loop electrosurgical excision procedure(LEEP)and cold-knife conization(CKC)on treating patients with high-grade squamous intraepithelial neoplasia(HSIL)in the cervix. Methods The medical records of 131 patients,diagnosed with HSIL,from 2015-01-01 to 2017-12-31 in The Third Affiliated Hospital of Guangzhou Medical University were reviewed. Eighty seven patients were treated with CKC while 44 with LEEP. The operation time and blood loss,postoperative residue rate,recurrence rate,complication rate,postoperative pregnancy rate and pregnancy outcomes of these two groups were compared. Results The operation time of LEEP was significantly shorter than that of CKC[(5.71±1.38)min vs.(32.25±14.35)min,P<0.05];intraoperative blood loss in LEEP was significantly lower than that of CKC[(3.57±1.51)mL vs.(18.12±9.23)mL]. The positive margin rate of LEEP was significantly higher than that of CKC(27.3% vs. 11.5%,P<0.05). But no significant difference in the cure rate[86.4%(LEEP)vs. 90.8%(CKC)],postoperative residual rate[7.1%(LEEP)vs. 5.1%(CKC)],and recurrence rate(2.6% vs. 0.0%)between these two groups(P>0.05). The postoperative complications rate of LEEP was 2.4%,obviously lower than that of CKC(13.9%),but not statistically significant(P>0.05). There were no statistically significant differences in postoperative pregnancy rate and pregnancy outcomes(P>0.05). Conclusion The treatment effect of LEEP was similar to that of CKC. However,LEEP has the advantages of short operation time and less intraoperative bleeding.
Objective To compare the clinical effect of loop electrosurgical excision procedure(LEEP)and cold-knife conization(CKC)on treating patients with high-grade squamous intraepithelial neoplasia(HSIL)in the cervix. Methods The medical records of 131 patients,diagnosed with HSIL,from 2015-01-01 to 2017-12-31 in The Third Affiliated Hospital of Guangzhou Medical University were reviewed. Eighty seven patients were treated with CKC while 44 with LEEP. The operation time and blood loss,postoperative residue rate,recurrence rate,complication rate,postoperative pregnancy rate and pregnancy outcomes of these two groups were compared. Results The operation time of LEEP was significantly shorter than that of CKC[(5.71±1.38)min vs.(32.25±14.35)min,P<0.05];intraoperative blood loss in LEEP was significantly lower than that of CKC[(3.57±1.51)mL vs.(18.12±9.23)mL]. The positive margin rate of LEEP was significantly higher than that of CKC(27.3% vs. 11.5%,P<0.05). But no significant difference in the cure rate[86.4%(LEEP)vs. 90.8%(CKC)],postoperative residual rate[7.1%(LEEP)vs. 5.1%(CKC)],and recurrence rate(2.6% vs. 0.0%)between these two groups(P>0.05). The postoperative complications rate of LEEP was 2.4%,obviously lower than that of CKC(13.9%),but not statistically significant(P>0.05). There were no statistically significant differences in postoperative pregnancy rate and pregnancy outcomes(P>0.05). Conclusion The treatment effect of LEEP was similar to that of CKC. However,LEEP has the advantages of short operation time and less intraoperative bleeding.
引文
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[12]宋冬冬,赵婧,彭伟.LEEP治疗310例宫颈病变的临床观察[J].热带医学杂志,2010,10(1):56-57,75.
[13]张燕萍,邓继红,张雯,等.宫颈冷刀锥切术在子宫颈疾病诊治中的应用[J].云南医药,2007,28(3):264-266.
[14]李莉,赵霞,张绪婷,等.宫颈环形电切术与冷刀锥切术治疗宫颈上皮内瘤变的Meta分析[J].中国妇幼保健,2017,32(10):2258-2263.
[15]Kyrgiou M,Arbyn M,Koliopoulos G,et al.Obstetric outcomes and fertility after conservative treatment for cervical intraepithelial lesions[J].Cochrane Database of Systematic Reviews,2017,11(1):CD012847.
[16]Bj?rge T,Skare GB,Bj?rge L,et al.Adverse pregnancy outcomes after treatment for cervical intraepithelial neoplasia[J].Obstet Gynecol,2016,128(6):1265-1273.
[17]Guo HJ,Guo RX,Liu YL.Effects of loop electrosurgical excision procedure or cold knife conization on pregnancy outcomes[J].Eur J Gynaecol Oncol,2013,34(1):79-82.
[2]McCredie MR,Sharples KJ,Paul C,et al.Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3:a retrospective cohort study[J].Lancet Oncol,2008,9(5):425-434.
[3]Wang Z,Li Z,Li J,et al.Prevalence and distribution of HPVgenotypes in 1 387 women with cervical intraepithelial neoplasia2/3 in Shanxi province,China[J].J Cancer,2018,9(16):2802-2806.
[4]踪佳鹏,冯文.宫颈环形电切术与冷刀锥切术治疗CINⅡ、Ⅲ级疗效分析[J].肿瘤基础与临床,2017,30(1):65-68.
[5]Marth C,Landoni F,Mahner S,et al.Cervical cancer:ESMOclinical practice guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2017,28(suppl_4):iv72-iv83.
[6]王悦,李明珠,魏丽惠.宫颈锥切——预防宫颈癌的重要防线[J].中国妇产科临床杂志,2015,16(1):5-7.
[7]蒋燕明,王鹤,贺红英,等.不同手术方式治疗宫颈上皮内瘤变的近、远期疗效分析[J].现代妇产科进展,2018,27(1):28-32.
[8]刘丹,程雪花.年轻女性宫颈癌患者临床特征与早期宫颈癌预后因素分析[J].热带医学杂志,2017,17(1):32-34.
[9]Del Mistro A,Matteucci M,Insacco EA,et al.Long-term clinical outcome after treatment for high-grade cervical lesions:A retrospective monoinstitutional cohort study[J].Biomed Res Int,2015,2015:984528.
[10]?rbo A,Arnesen T,Arnes M,et al.Resection margins in conization as rognostic marker for relapse in high-grade dysplasia of uterine cervix in northern norway:a retrospective long-term follow-up material[J].Gynecol Oncol,2004,93(2):479-483.
[11]刘淼,齐跃,刘娟娟,等.宫颈上皮内瘤变宫颈锥切术后二次手术术式探讨及临床疗效分析[J].中国实用妇科与产科杂志,2018,34(3):298-303.
[12]宋冬冬,赵婧,彭伟.LEEP治疗310例宫颈病变的临床观察[J].热带医学杂志,2010,10(1):56-57,75.
[13]张燕萍,邓继红,张雯,等.宫颈冷刀锥切术在子宫颈疾病诊治中的应用[J].云南医药,2007,28(3):264-266.
[14]李莉,赵霞,张绪婷,等.宫颈环形电切术与冷刀锥切术治疗宫颈上皮内瘤变的Meta分析[J].中国妇幼保健,2017,32(10):2258-2263.
[15]Kyrgiou M,Arbyn M,Koliopoulos G,et al.Obstetric outcomes and fertility after conservative treatment for cervical intraepithelial lesions[J].Cochrane Database of Systematic Reviews,2017,11(1):CD012847.
[16]Bj?rge T,Skare GB,Bj?rge L,et al.Adverse pregnancy outcomes after treatment for cervical intraepithelial neoplasia[J].Obstet Gynecol,2016,128(6):1265-1273.
[17]Guo HJ,Guo RX,Liu YL.Effects of loop electrosurgical excision procedure or cold knife conization on pregnancy outcomes[J].Eur J Gynaecol Oncol,2013,34(1):79-82.