宮頸環(huán)形電切術(shù)（LEEP）與宮頸冷刀錐切術(shù)（CKC）治療高級別上皮內(nèi)瘤變的療效比較
發(fā)布時間：2018-08-02 07:59
【摘要】：背景和目的 宮頸癌是全球最常見的婦科腫瘤之一,目前已明確宮頸上皮內(nèi)瘤變(Cervical Intraepithelial Neoplasia, CIN)是宮頸癌的癌前病變,其中高級別上皮內(nèi)瘤變與宮頸癌的關(guān)系更為密切。因此,CIN的早期診斷及合理治療已成為降低宮頸癌發(fā)病率及病死率的重要手段。目前,臨床上宮頸環(huán)形電切術(shù)(LoopElectrosurgicalExcision Procedure, LEEP)和冷刀錐切術(shù)(Cold Knife Conization, CKC)為治療CIN的主要手術(shù)方式,本課題采用臨床回顧性分析的方法,對136例CINII-CINIII的患者進(jìn)行臨床分析,比較兩種手術(shù)方法治療CINII-CINIII的療效。 方法 回顧2011年1月1日至2013年12月31日間,山東大學(xué)齊魯醫(yī)院門診和住院治療的CINII-CINIII患者臨床資料。選擇臨床資料完整且無其他內(nèi)外科合并癥的136例患者進(jìn)行研究,根據(jù)患者手術(shù)方式不同分為LEEP組和CKC組,兩組患者均在月經(jīng)干凈后3-7d內(nèi)手術(shù)。在術(shù)前一般情況及錐切術(shù)后實際病變范圍無差異的前提下,比較兩組患者的出血量及手術(shù)時間、術(shù)前術(shù)后病理一致率、術(shù)后累腺率、錐切組織大小、宮頸病變范圍及病變最深處距離切緣的距離、術(shù)后切緣陽性率、術(shù)后復(fù)發(fā)率及術(shù)后妊娠的指標(biāo)。采用SPSS16.0統(tǒng)計軟件對數(shù)據(jù)進(jìn)行統(tǒng)計分析。 結(jié)果 1.兩組術(shù)中出血量及手術(shù)時間：LEEP組平均術(shù)中出血量為(11.98±9.59)ml,手術(shù)時間為(15.34±8.59)min;CKC組平均術(shù)中出血量為(27.77±24.84)ml,手術(shù)時間為(24.53±7.89)min;LEEP組均明顯小于CKC組,差異具有統(tǒng)計學(xué)意義(P0.05,P0.05)。 2.術(shù)前和術(shù)后病理：LEEP組術(shù)后病理結(jié)果為CINⅡ-CINⅢ者55例(84.62%),術(shù)后病理為CINⅠ者5例(7.69%),宮頸慢性炎癥者5例(7.69%)；CKC組術(shù)后病理結(jié)果為CINⅡ-CINⅢ者58例(81.69%),術(shù)后病理為CINⅠ者為2例(2.82%),宮頸慢性炎癥和慢炎伴鱗狀上皮化生者為10例(14.09%),微小浸潤癌者1例(1.41%)。兩組術(shù)前、術(shù)后病理一致率比較,差異無統(tǒng)計學(xué)意義(P0.05)。 3.術(shù)后累腺率：LEEP組術(shù)后病理累及腺體者為44例(67.69%)；CKC組術(shù)后病理累及腺體者為40例(56.34%)。兩組錐切術(shù)后累及腺體陽性率比較,差異無統(tǒng)計學(xué)意義(P0.05)。 4.錐切組織大�。篖EEP組術(shù)后平均錐切組織面積為(4.31±1.51)cm2,平均錐高為(1.38±0.33)cm;CKC組術(shù)后平均錐切組織面積為(5.07±1.48)cm2,平均錐高為(2.03±0.44)cm。兩組錐切組織面積、錐高比較,差異具有統(tǒng)計學(xué)意義(P0.05；P0.05)。 5.宮頸病變最深處到切緣的距離：LEEP組術(shù)后平均病變深度為(0.71±0.23)mm,病變最深處到切緣的距離2mm的患者63例,≤2mm的患者2例：CKC組術(shù)后平均病變深度為(0.62±0.37)mm,病變最深處到切緣的距離2mm的患者69例,≤2mm的患者2例；病變最深處到切緣的距離兩組術(shù)后實際病變面積、病變深度及病變最深處到切緣的距離的比較,差異均無統(tǒng)計學(xué)意義(P0.05,P0.05)。 6.術(shù)后切緣陽性率：LEEP組術(shù)后切緣陽性者為2例(3.1%)；CKC組切緣陽性者為0例(0%)。兩組術(shù)后切緣陰性率比較,差異無統(tǒng)計學(xué)意義(P0.05)。 7.術(shù)后復(fù)發(fā)情況：LEEP組術(shù)后復(fù)發(fā)3例(3.08%),CKC組復(fù)發(fā)2例(4.22%)。兩組術(shù)后復(fù)發(fā)率比較,差異無統(tǒng)計學(xué)意義(P0.05)。 8.術(shù)后妊娠情況：LEEP組術(shù)后妊娠的患者有3例(4.62%),1例宮外孕,1例孕早期行宮頸環(huán)扎術(shù),1例足月剖宮產(chǎn)分娩；CKC組2例(2.82%),1例早產(chǎn),1例孕早期行宮頸環(huán)扎術(shù)。兩組術(shù)后妊娠率的比較,差異無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論 1.LEEP與CKC在治療高級別上皮內(nèi)瘤變時,手術(shù)療效及術(shù)后復(fù)發(fā)率無差異。 2.LEEP與CKC相比,術(shù)中出血量少,手術(shù)時間短,術(shù)中錐切宮頸組織小,對患者創(chuàng)傷小,術(shù)后恢復(fù)快,易于被患者接受。
[Abstract]:Background and purpose
Cervical cancer is one of the most common gynecologic tumors in the world. It is now clear that Cervical Intraepithelial Neoplasia (CIN) is the precancerous lesion of cervical cancer, of which high grade intraepithelial neoplasia is more closely related to cervical cancer. Therefore, early diagnosis and rational treatment of CIN have become a reduction in the incidence and disease of cervical cancer. At present, LoopElectrosurgicalExcision Procedure (LEEP) and cold knife coning (Cold Knife Conization, CKC) are the main surgical methods for the treatment of CIN. In this subject, 136 cases of CINII-CINIII were analyzed by clinical retrospective analysis, and two kinds of operations were compared. Methods the curative effect of CINII-CINIII was treated.
Method
The clinical data of CINII-CINIII patients in the Qilu Hospital of Shandong University from January 1, 2011 to December 2013 were reviewed. 136 patients with complete clinical data and no other internal and external complications were selected for the study. The patients were divided into group LEEP and CKC according to the different surgical methods, and the two groups were in 3-7d after menstruation clean. Operation. On the premise of the preoperative general condition and the actual lesion range after conization, the bleeding volume and operation time of the two groups, the preoperative and postoperative pathologic consistent rate, the postoperative cumulative gland rate, the size of the conical tissue, the range of the cervical lesions and the distance from the most deep edge of the lesion, the positive rate of the postoperative cutting edge, the postoperative recurrence rate and the pregnancy induced pregnancy rate were compared. The data were analyzed by SPSS16.0 statistical software.
Result
1. the amount of bleeding and operation time in the two groups: the average bleeding amount in group LEEP was (11.98 + 9.59) ml and the operation time was (15.34 + 8.59) min; the average bleeding volume in group CKC was (27.77 + 24.84) ml and the operation time was (24.53 + 7.89) min, LEEP group was obviously smaller than that of CKC group, the difference was statistically significant (P0.05, P0.05).
2. preoperative and postoperative pathology: the pathological results of group LEEP after operation were 55 cases (84.62%) of CIN II -CIN III, 5 cases of CIN I (7.69%), 5 cases of chronic cervical inflammation (7.69%), and CKC group of CIN II -CIN III (81.69%), 2 cases (2.82%), chronic inflammation of cervix and slow inflammation with squamous metaplasia. There were 10 cases (14.09%) and 1 case (1.41%) of minimal invasive carcinoma. There was no significant difference in pathological consistency between the two groups before and after operation (P 0.05).
3. after operation, the rate of accumulation of glands in group LEEP was found in 44 cases (67.69%) and 40 cases (56.34%) of pathological glands in group CKC after operation (56.34%). There was no significant difference in the positive rate of glands in the two groups after coning (P0.05).
The size of 4. cone cut tissue: the average conical area of group LEEP after operation was (4.31 + 1.51) cm2 and the average cone height was (1.38 + 0.33) cm. The mean conical area of group CKC after operation was (5.07 + 1.48) cm2, and the average cone height was (2.03 + 0.44) cm. of two conical tissue area, and the cone height was compared. The difference was statistically significant (P0.05; P0.05).
5. the distance between the most deep cervical lesions to the cutting edge: the average lesion depth of group LEEP was (0.71 + 0.23) mm after operation, 63 cases of the distance 2mm from the most deep to the cutting edge, 2 cases of the patients less than 2mm: the average lesion depth in the CKC group was (0.62 + 0.37) mm, the depth of the lesion to the cutting edge of 2mm was 69 cases, and the patients of less than 2mm were the most deep. There was no significant difference in the area of the two groups, the depth of the lesion and the distance from the most deep to the cutting edge of the two groups (P0.05, P0.05).
6. after operation, the positive rate of tangent margin was 2 cases (3.1%) in group LEEP and 0 cases (0%) with positive margin in group CKC (0%). There was no statistical difference between the two groups after operation (P0.05).
7. Postoperative recurrence: 3 cases (3.08%) in LEEP group and 2 cases (4.22%) in CKC group. There was no significant difference in recurrence rate between the two groups (P 0.05).
8. postoperatively, there were 3 cases (4.62%), 1 cases of ectopic pregnancy in group LEEP, 1 cases of cervix cerclage in the early stage of pregnancy, 1 cases of full term cesarean section, 2 cases in group CKC (2.82%), 1 cases of preterm labor, and 1 cases of pregnancy by cervical cerclage. The difference of pregnancy rate after group two was not statistically significant (P0.05).
conclusion
There is no difference in operative efficacy and postoperative recurrence rate between 1.LEEP and CKC in the treatment of high-grade intraepithelial neoplasia.
2. Compared with CKC, LEEP has less bleeding, shorter operation time, smaller cervical tissue conization, less trauma to patients, faster recovery and easy to be accepted by patients.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.33
本文編號：2158734
[Abstract]:Background and purpose
Cervical cancer is one of the most common gynecologic tumors in the world. It is now clear that Cervical Intraepithelial Neoplasia (CIN) is the precancerous lesion of cervical cancer, of which high grade intraepithelial neoplasia is more closely related to cervical cancer. Therefore, early diagnosis and rational treatment of CIN have become a reduction in the incidence and disease of cervical cancer. At present, LoopElectrosurgicalExcision Procedure (LEEP) and cold knife coning (Cold Knife Conization, CKC) are the main surgical methods for the treatment of CIN. In this subject, 136 cases of CINII-CINIII were analyzed by clinical retrospective analysis, and two kinds of operations were compared. Methods the curative effect of CINII-CINIII was treated.
Method
The clinical data of CINII-CINIII patients in the Qilu Hospital of Shandong University from January 1, 2011 to December 2013 were reviewed. 136 patients with complete clinical data and no other internal and external complications were selected for the study. The patients were divided into group LEEP and CKC according to the different surgical methods, and the two groups were in 3-7d after menstruation clean. Operation. On the premise of the preoperative general condition and the actual lesion range after conization, the bleeding volume and operation time of the two groups, the preoperative and postoperative pathologic consistent rate, the postoperative cumulative gland rate, the size of the conical tissue, the range of the cervical lesions and the distance from the most deep edge of the lesion, the positive rate of the postoperative cutting edge, the postoperative recurrence rate and the pregnancy induced pregnancy rate were compared. The data were analyzed by SPSS16.0 statistical software.
Result
1. the amount of bleeding and operation time in the two groups: the average bleeding amount in group LEEP was (11.98 + 9.59) ml and the operation time was (15.34 + 8.59) min; the average bleeding volume in group CKC was (27.77 + 24.84) ml and the operation time was (24.53 + 7.89) min, LEEP group was obviously smaller than that of CKC group, the difference was statistically significant (P0.05, P0.05).
2. preoperative and postoperative pathology: the pathological results of group LEEP after operation were 55 cases (84.62%) of CIN II -CIN III, 5 cases of CIN I (7.69%), 5 cases of chronic cervical inflammation (7.69%), and CKC group of CIN II -CIN III (81.69%), 2 cases (2.82%), chronic inflammation of cervix and slow inflammation with squamous metaplasia. There were 10 cases (14.09%) and 1 case (1.41%) of minimal invasive carcinoma. There was no significant difference in pathological consistency between the two groups before and after operation (P 0.05).
3. after operation, the rate of accumulation of glands in group LEEP was found in 44 cases (67.69%) and 40 cases (56.34%) of pathological glands in group CKC after operation (56.34%). There was no significant difference in the positive rate of glands in the two groups after coning (P0.05).
The size of 4. cone cut tissue: the average conical area of group LEEP after operation was (4.31 + 1.51) cm2 and the average cone height was (1.38 + 0.33) cm. The mean conical area of group CKC after operation was (5.07 + 1.48) cm2, and the average cone height was (2.03 + 0.44) cm. of two conical tissue area, and the cone height was compared. The difference was statistically significant (P0.05; P0.05).
5. the distance between the most deep cervical lesions to the cutting edge: the average lesion depth of group LEEP was (0.71 + 0.23) mm after operation, 63 cases of the distance 2mm from the most deep to the cutting edge, 2 cases of the patients less than 2mm: the average lesion depth in the CKC group was (0.62 + 0.37) mm, the depth of the lesion to the cutting edge of 2mm was 69 cases, and the patients of less than 2mm were the most deep. There was no significant difference in the area of the two groups, the depth of the lesion and the distance from the most deep to the cutting edge of the two groups (P0.05, P0.05).
6. after operation, the positive rate of tangent margin was 2 cases (3.1%) in group LEEP and 0 cases (0%) with positive margin in group CKC (0%). There was no statistical difference between the two groups after operation (P0.05).
7. Postoperative recurrence: 3 cases (3.08%) in LEEP group and 2 cases (4.22%) in CKC group. There was no significant difference in recurrence rate between the two groups (P 0.05).
8. postoperatively, there were 3 cases (4.62%), 1 cases of ectopic pregnancy in group LEEP, 1 cases of cervix cerclage in the early stage of pregnancy, 1 cases of full term cesarean section, 2 cases in group CKC (2.82%), 1 cases of preterm labor, and 1 cases of pregnancy by cervical cerclage. The difference of pregnancy rate after group two was not statistically significant (P0.05).
conclusion
There is no difference in operative efficacy and postoperative recurrence rate between 1.LEEP and CKC in the treatment of high-grade intraepithelial neoplasia.
2. Compared with CKC, LEEP has less bleeding, shorter operation time, smaller cervical tissue conization, less trauma to patients, faster recovery and easy to be accepted by patients.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.33
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