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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1 147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。
Objective To analyze and evaluate the clinical data and curative effect of cervical ring incision (CIN) treated with fine ring electrode cervical cone conization (LEEP). Methods A total of 1,147 patients treated with modified LEEP surgery at the First Affiliated Hospital of Xi’an Jiaotong University from April 2009 to March 2014 were analyzed with regard to the incidence of maternal condition, pathological diagnosis, efficacy and complications , Residual, recurrence and so on. Results The overall average age of onset of CIN1, CIN2, CIN3, early invasive cancer and so on was 40.61 years old. The first intercourse to clinical diagnosis was 17.86 years, the average number of pregnancies was 2.78 and the average production was 1.51. There was no statistical difference between the above groups in CIN Significance (all P> 0.05). LEEP preoperative and postoperative pathological findings relative diagnostic accuracy was 80.82%, the absolute diagnostic accuracy was 59.29%, postoperative pathological grade increased 27.99% compared with preoperative, reduced 18.22%, the positive rate of surgical margin 15.97%. A single LEEP cure rate was 96.16%, complications 2.53%, disease residual rate of 2.53%, the recurrence rate of 0.52%. Postoperative HPV negative rate of 86.17%. Postoperative pregnancy, production function had no effect. Conclusion LEEP is a highly effective, concise, safe and economical method for the treatment of CIN. Refinement of the combination of an individualized precise excision and a rigorous electrocoagulation can significantly improve the therapeutic effect.