上推膀胱直肠后再次宫颈环形电切术对保留生育功能的价值

发布时间：2018-04-01 19:00

本文选题：上推膀胱直肠　切入点：再次宫颈环形电切术　出处：《实用妇产科杂志》2015年01期

【摘要】：目的:探讨上推膀胱直肠后再次宫颈环形电切术(LEEP)在宫颈疾病治疗中的可行性,评价其对年轻患者保留子宫及生育功能的价值。方法:回顾性分析2010年1月至2014年4月在复旦大学附属妇产科医院就诊,因宫颈LEEP术后切缘阳性或术后随访复发、无法在门诊行常规LEEP而行上推膀胱直肠后再次LEEP的38例患者的临床资料。结果:38例患者均顺利完成了上推膀胱直肠后再次LEEP,术中均未出现膀胱、直肠损伤等并发症。手术时间38±7分钟,术中出血量20±5 ml,住院天数2.7±0.6天;其中1例患者术前病理检查为宫颈高度鳞状上皮内瘤变,术后升级为原位鳞癌合并原位腺癌行全子宫切除术,37例患者(97.4%)成功保留子宫,随访至今1例术后12个月低度鳞状上皮内瘤变行宫颈激光治疗,余均未见宫颈病变复发。12例患者有生育意愿,7例患者已成功妊娠,6例已分娩。结论:上推膀胱直肠后再次LEEP安全可行,可实现未生育妇女及年轻妇女保留子宫及生育能力的意愿。
[Abstract]:Objective: to investigate the feasibility of the treatment of cervical diseases by the loop electroresection of the cervix (LEEP) after pushing up the bladder and rectum. Methods: from January 2010 to April 2014, the patients were treated at the affiliated Obstetrics and Gynecology Hospital of Fudan University. Clinical data of 38 patients who were unable to perform routine LEEP in outpatient department but who underwent LEEP after pushing up the bladder and rectum. Results all the 38 patients successfully completed LEEPs after pushing up the bladder rectum, and no bladder was found during the operation. The operative time was 38 卤7 minutes, the intraoperative bleeding was 20 卤5 ml, and the hospital stay was 2.7 卤0.6 days. After operation, 37 patients with squamous cell carcinoma complicated with adenocarcinoma in situ underwent hysterectomy (97. 4%). One case of low grade squamous intraepithelial neoplasia after 12 months of operation was treated by laser therapy. There was no recurrence of cervical lesions in all the 12 cases. 7 cases had successful pregnancy and 6 cases had delivered. Conclusion: LEEP is safe and feasible after pushing up the bladder and rectum. It can realize the will of the childless women and young women to keep the uterus and fertility.
【作者单位】：复旦大学附属妇产科医院;江苏省常州市新北区薛家人民医院;
【分类号】：R737.33

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