微创医学

目的探讨环形电外科切除术（loop electrosurgical excision procedure，LEEP）在宫颈上皮内瘤变（CIN）伴高危型人乳头瘤病毒（HPV）感染患者中的应用效果。方法采用LEEP治疗98例CIN伴HRHPV感染患者，手术前后均行HRHPV检测，观察手术效果及HRHPV变化。结果所有患者均顺利完成手术，术后随访1年，治愈率为90.8%（89/98），复发率为9.2%（9/98）；其中CINⅠ患者治愈率为100%（64/64），显著高于CINⅡ～Ⅲ患者的73.5%（25/34）（P＜0.01），CINⅠ患者复发率显著低于CINⅡ～Ⅲ患者（P＜0.01）。术后6个月HRHPV阳性率为31.6%（31/98），显著低于治疗前（P＜0.01），转阴率为68.4%（67/98）；术后1年HRHPV阳性率再次显著下降为15.3%（15/98）（P＜0.01），转阴率为84.7%（83/98）（P＜0.01）。结论LEEP治疗CIN疗效显著，且可消除大部分HRHPV感染，降低CIN复发率及宫颈癌发生率，操作简便，并发症较少，值得推广。

ObjectiveTo study the clinical effects of loop electrosurgical excision procedure (LEEP) in cervical intraepithelial neoplasia (CIN) patients with high risk human papilloma virus (HRHPV) infection. MethodsNinetyeight CIN patients with HRHPV infection were treated with LEEP. All patients were performed with HRHPV test both before and after LEEP. Clinical effects of the patients were assessed. ResultsAll patients were successfully operated. The cure rate was 90.8% (89/98), and the recurrence rate was 9.2% (9/98) after 1 year followup. The cure rate in patients with CIN Ⅰ was 100% (64/64), significantly higher than 73.5% (25/34) in patients with CIN Ⅱ-Ⅲ(P＜0.01), and the recurrence rate of patients with CIN Ⅰ was significantly lower than that of patients with CIN Ⅱ-Ⅲ(0% versus 26.5%,P＜0.01). Positive rate of HRHPV was 31.6% (31/98) 6 months after the treatment, significantly lower than that before LEEP(P＜0.01), and negative conversion rate was 68.4% (67/98); and 1 year later, they continued to decrease to 15.3% (15/98) and 84.7% (83/98), respectively, all with statistical significance (P＜0.01). ConclusionLEEP is effective in the treatment of CIN, also it can eliminate most of the HR HPV infections, thus reduce the recurrence rate of CIN and incidence of cervical cancer. In addition, it′s easy to operate, with fewer complications, and worthy of promotion.