摘要
目的 了解阴道镜检查在指导宫颈上皮内瘤变(CIN)治疗中的价值。方法 对171 例经阴道镜诊断为CIN或阴道镜+活检明确诊断为CIN的患者,在肉眼观察下行宫颈环状电热切除术(LEEP)治疗,术后即刻行阴道镜检查,有异常图像残留者,于超出异常部位5 mm 再次行局部切除;无异常图像者,则根据糜烂面大小作相应的糜烂面切除以作病理对照。前、后两次的切除标本分瓶送病理检查。所有患者于术后1、3、6、12、24个月随访其临床症状。对术后病理切缘阳性患者于术后1 个月行阴道镜检查,有异常图像者再次行LEEP治疗,并做病理检查;无异常图像者作多点活检。切缘阴性患者于术后3、6、12、24个月行阴道镜及细胞学检查,如连续2次活检和细胞学检查为阴性,常规每年作1次阴道镜检查和细胞学检查(随访中若有异常图像时再作活检)。结果 肉眼下LEEP阳性24例,手术残留率为14.04%(24/171例);阴道镜下LEEP切缘阳性2 例,手术残留率为1.17%(2/171例),两者的差异有显著性(P<0.0001)。164 例患者术后3 个月再次行LEEP治疗,发现病变持续存在2例,病变持续存在率为1.22%(2/164 例)。166 例患者获得随访,复发率为0.60%(1/166例)。结论 阴道镜检查指导LEEP治疗CIN具有低残留、低复发、高治愈的特点。阴道镜检查是一种安全。
Objective To evaluate the instructive value of colposcopy in the treatment of cervical intraepithelial neoplasm(CIN). Methods One hundred and seventy-one patients diagnosed as CIN by colposcopy with or without biopsy were enrolled. LEEP was performed directly and followed by colposcopy. Patients’ local resections were performed with abnormal colposcopic findings, and removal of erosive surface of normal region were taken as the pathologic control. The two specimens from the same patient were sent separately. All patients were followed up 1,3,6,12,24 months after LEEP; patients with the positive resected margin were performed colposcopy one month after LEEP. Patients with abnormal colposcopic findings performed LEEP once again; patients with no abnomality underwent multiple biopies. Patients with negative resection margin were followed up by colposcopy and PAP smear 3,6,12,24 months after LEEP. Patients with normal biopsy and PAP smear twice successively were followed up by colposcopy and PAP smear annually. Patients with abnormal colposcopic findings again required biopsies during follow-up. Results There were 24 patients with positive resected margin derectly in LEEP(14.04%), other 2 in LEEP with guided colposcopy(1.17%, P<0.0001). 2/164 (1.22%) patients with persistent lesion were undertaken a second LEEP or biopsy 3 months later. CIN recurrence was present in 1/166 patient (0.60%) during the regular follow-up. Conclusion Colposcopic guided LEEP leaves low residual lesion, low recurrence and high cure rate for the treatment of CIN. Colposcopy is also safe and practical for follow-up study.
出处
《上海医学》
CAS
CSCD
北大核心
2005年第3期195-198,共4页
Shanghai Medical Journal
