宫颈环形电切术（LEEP）与宫颈冷刀锥切术（CKC）治疗高级别上皮内瘤变的疗效比较
发布时间：2018-08-02 07:59
【摘要】：背景和目的 宫颈癌是全球最常见的妇科肿瘤之一,目前已明确宫颈上皮内瘤变(Cervical Intraepithelial Neoplasia, CIN)是宫颈癌的癌前病变,其中高级别上皮内瘤变与宫颈癌的关系更为密切。因此,CIN的早期诊断及合理治疗已成为降低宫颈癌发病率及病死率的重要手段。目前,临床上宫颈环形电切术(LoopElectrosurgicalExcision Procedure, LEEP)和冷刀锥切术(Cold Knife Conization, CKC)为治疗CIN的主要手术方式,本课题采用临床回顾性分析的方法,对136例CINII-CINIII的患者进行临床分析,比较两种手术方法治疗CINII-CINIII的疗效。 方法 回顾2011年1月1日至2013年12月31日间,山东大学齐鲁医院门诊和住院治疗的CINII-CINIII患者临床资料。选择临床资料完整且无其他内外科合并症的136例患者进行研究,根据患者手术方式不同分为LEEP组和CKC组,两组患者均在月经干净后3-7d内手术。在术前一般情况及锥切术后实际病变范围无差异的前提下,比较两组患者的出血量及手术时间、术前术后病理一致率、术后累腺率、锥切组织大小、宫颈病变范围及病变最深处距离切缘的距离、术后切缘阳性率、术后复发率及术后妊娠的指标。采用SPSS16.0统计软件对数据进行统计分析。 结果 1.两组术中出血量及手术时间：LEEP组平均术中出血量为(11.98±9.59)ml,手术时间为(15.34±8.59)min;CKC组平均术中出血量为(27.77±24.84)ml,手术时间为(24.53±7.89)min;LEEP组均明显小于CKC组,差异具有统计学意义(P0.05,P0.05)。 2.术前和术后病理：LEEP组术后病理结果为CINⅡ-CINⅢ者55例(84.62%),术后病理为CINⅠ者5例(7.69%),宫颈慢性炎症者5例(7.69%)；CKC组术后病理结果为CINⅡ-CINⅢ者58例(81.69%),术后病理为CINⅠ者为2例(2.82%),宫颈慢性炎症和慢炎伴鳞状上皮化生者为10例(14.09%),微小浸润癌者1例(1.41%)。两组术前、术后病理一致率比较,差异无统计学意义(P0.05)。 3.术后累腺率：LEEP组术后病理累及腺体者为44例(67.69%)；CKC组术后病理累及腺体者为40例(56.34%)。两组锥切术后累及腺体阳性率比较,差异无统计学意义(P0.05)。 4.锥切组织大小：LEEP组术后平均锥切组织面积为(4.31±1.51)cm2,平均锥高为(1.38±0.33)cm;CKC组术后平均锥切组织面积为(5.07±1.48)cm2,平均锥高为(2.03±0.44)cm。两组锥切组织面积、锥高比较,差异具有统计学意义(P0.05；P0.05)。 5.宫颈病变最深处到切缘的距离：LEEP组术后平均病变深度为(0.71±0.23)mm,病变最深处到切缘的距离2mm的患者63例,≤2mm的患者2例：CKC组术后平均病变深度为(0.62±0.37)mm,病变最深处到切缘的距离2mm的患者69例,≤2mm的患者2例；病变最深处到切缘的距离两组术后实际病变面积、病变深度及病变最深处到切缘的距离的比较,差异均无统计学意义(P0.05,P0.05)。 6.术后切缘阳性率：LEEP组术后切缘阳性者为2例(3.1%)；CKC组切缘阳性者为0例(0%)。两组术后切缘阴性率比较,差异无统计学意义(P0.05)。 7.术后复发情况：LEEP组术后复发3例(3.08%),CKC组复发2例(4.22%)。两组术后复发率比较,差异无统计学意义(P0.05)。 8.术后妊娠情况：LEEP组术后妊娠的患者有3例(4.62%),1例宫外孕,1例孕早期行宫颈环扎术,1例足月剖宫产分娩；CKC组2例(2.82%),1例早产,1例孕早期行宫颈环扎术。两组术后妊娠率的比较,差异无统计学意义(P0.05)。 结论 1.LEEP与CKC在治疗高级别上皮内瘤变时,手术疗效及术后复发率无差异。 2.LEEP与CKC相比,术中出血量少,手术时间短,术中锥切宫颈组织小,对患者创伤小,术后恢复快,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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33
本文编号：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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33
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