CAJ | 학술논문

目的：分析和评价经精细化环形电极宫颈锥切术（ LEEP）治疗宫颈上皮内瘤变（ CIN）病例的相关临床资料和疗效。方法分析2009年4月至2014年3月在西安交通大学第一附属医院经改良的精细化LEEP术治疗的1147例患者的与发病相关的孕产状况、手术前后病理诊断、疗效、并发症、残留、复发等情况。结果 CIN1、CIN2、CIN3、早期浸润癌等总体平均发病年龄40．61岁，初次性交至临床诊断间期为17．86年，平均孕次2．78，平均产次1．51，以上各项在CIN组间差异无统计学意义（均P＞0．05）。 LEEP术前、后病理结果相对诊断符合率为80．82％，绝对诊断符合率为59．29％，术后病理级别较术前加重27．99％、减轻18．22％，手术切缘阳性率15．97％。单次LEEP术治愈率96．16％，并发症2．53％，病变残留率2．53％，复发率0．52％。术后HPV转阴率86．17％。术后孕、产功能未见影响。结论 LEEP术是治疗CIN针对性极高的高效、简洁、安全和经济的方法。个体化的精确切除和严密电凝相结合的精细化处理能显著提高治疗效果。
목적：분석화평개경정세화배형전겁궁경추절술（ LEEP）치료궁경상피내류변（ CIN）병례적상관림상자료화료효。방법분석2009년4월지2014년3월재서안교통대학제일부속의원경개량적정세화LEEP술치료적1147례환자적여발병상관적잉산상황、수술전후병리진단、료효、병발증、잔류、복발등정황。결과 CIN1、CIN2、CIN3、조기침윤암등총체평균발병년령40．61세，초차성교지림상진단간기위17．86년，평균잉차2．78，평균산차1．51，이상각항재CIN조간차이무통계학의의（균P＞0．05）。 LEEP술전、후병리결과상대진단부합솔위80．82％，절대진단부합솔위59．29％，술후병리급별교술전가중27．99％、감경18．22％，수술절연양성솔15．97％。단차LEEP술치유솔96．16％，병발증2．53％，병변잔류솔2．53％，복발솔0．52％。술후HPV전음솔86．17％。술후잉、산공능미견영향。결론 LEEP술시치료CIN침대성겁고적고효、간길、안전화경제적방법。개체화적정학절제화엄밀전응상결합적정세화처리능현저제고치료효과。
Objective To analyze and evaluate the effectiveness of the refined loop electrosurgical excision procedure ( LEEP) treatment for cervical intraepithelial neoplasia ( CIN) and related clinical data.Methods The clinical data of 1 147 cases of CIN treated by the refined LEEP in the First Affiliated Hospital of Xi’ an Jiaotong University during April 2009 to March 2014 were analyzed, including pregnancy and gravidity, pathologic diagnosis before and after surgery, curative efficacy, complications, residual and recurrence.Results The average diagnostic age of CIN cases was 40.61 years old with an average sexual experience period of 17.86 years.The mean gravidity and delivery number was 2.78 and 1.51, respectively.All of these data showed no significant difference among CIN groups (all P>0.05).The relative concordance rate of pathologic diagnosis before and after LEEP was 80.82%, and the absolute concordance rate was 59.29%.It increased by 27.99%and decreased by 18.22%in CIN grades.The incisal margin of the LEEP specimen was positive in 15.97%of the cases.The final curative rate, incidence of complications, residue rate and relapse rate after single LEEP were 96.16%, 2.53%, 2.53%and 0.52%, respectively.There were 86.17%of the HPV positive cases becoming negative after LEEP.The eugenesis change was not found after LEEP.Conclusion LEEP is a highly effective, safe and simple method for treatment of CINs.Refined procedure of individualized accurate excision combined with electrocoagulation can promote the effectiveness of surgery remarkably.