冷冻技术在宫颈病变中个性化治疗的应用价值
The application value of cryotherapy in the personalized treatment of cervical lesions
-
摘要: 目的：探讨冷冻技术在宫颈病变中个性化治疗的应用价值。方法：选择持续高危型人乳头瘤病毒（HPV）感染及低度宫颈癌前病变病人作为研究对象，根据年龄（25~30岁）及生育要求采用冷冻术、LEEP术及激光术治疗宫颈病变者各40例。观察3组病人术中情况包括手术时间、术中出血量，术后3个月阴道镜检查结果、宫颈挛缩情况以及治疗前后宫颈管长度的改变情况，术后6个月HPV转阴率情况，术后2年内生育情况，包括经阴道分娩情况及流产情况等。结果：手术时间方面，LEEP术和激光术差异无统计学意义（P>0.05），但均短于冷冻术（P<0.01）；术中出血量方面，冷冻术无出血，LEEP术出血量高于激光术的出血量（P<0.01）。术后3个月随访，阴道镜病理异常率方面，3组病人差异均无统计学意义（P>0.05）；宫颈挛缩率方面，行冷冻术者宫颈挛缩率低于行LEEP术者（P<0.05），行激光术与行LEEP术病人宫颈挛缩率差异无统计学意义（P>0.05）；行冷冻术病人术后宫颈管长度无变化，行LEEP术病人宫颈管长度变化为（5.45±2.03）mm，大于行激光术的（3.31±1.82）mm（P<0.01）；术后6个月，3组病人HPV转阴率之间差异无统计学意义（P>0.05）。术后2年内生育情况，3组病人的怀孕率差异无统计学意义（P>0.05）；行冷冻术者阴道分娩率为74.07%，高于行LEEP术者的41.67%和行激光术者的48.00%（P<0.05），行LEEP术者与行激光术者阴道分娩率差异无统计学意义（P>0.05）；行LEEP术者、激光术者和冷冻术者流产率分别为20.83%、8.00%和0.00%，行冷冻术者流产率低于行LEEP术者（P<0.05）。结论：宫颈冷冻术治疗后愈合不留瘢痕，不会造成宫颈管长度的改变、宫颈粘连和挛缩，不影响生育功能，适用于年轻未生育过或需保留生育功能的女性病人。Abstract: Objective: To investigate application value of cryotherapy in the personalized treatment of cervical lesions.Methods: The high-risk HPV infection and low cervical precancerous lesions patients were investigated.The patients were treated with cervical cryotherapy,loop electrosurgical excision procedure(LEEP) and cervical laser surgery according to the age(25 to 30 years old) and fertility requirements(40 cases each group).The operation time,intraoperative blood loss,postoperative 3 months colposcopy,cervical contracture,length change of cervical canal between before and after treatment,postoperative 6 months negative conversion rate of HPV,postoperative 2 years fertility condition(including vaginal delivery and miscarriage) in three groups were observed.Results: The difference of operation time between LEEP and cervical laser surgery was not statistically significant(P>0.05),and which was shorter than that in cervical cryotherapy(P<0.01).No bleeding was found in cryosurgery operation,the intraoperative blood loss in LEEP was higher than that in laser surgery(P<0.01).During the 3 months of following-up,the differences of abnormal pathology rates among three groups were not statistically significant(P>0.05).The cervical contracture rate in cryotherapy was lower than that in LEEP surgery,and the difference of cervical contracture rate between laser surgery and LEEP was not statistically significant(P>0.05).No postoperative change of cervical tube length was found in cryotherapy surgery,and the cervical tube length change in LEEP surgery was more than that in laser surgery(P<0.01).The differences of the negative conversion rate of HPV at postoperative 6 months,and pregnant rate at postoperative 2 months among three groups were not statistically significant(P>0.05).The vaginal delivery rate in patients treated with cryotherapy(74.07%) was higher than that in the patients treated with LEEP(41.67%) and cervical cryotherapy(48.00%)(P<0.05),and the difference of which between LEEP and laser surgery patients was not statistically significant(P >0.05).The abortion rates in LEEP,laser surgery and cryotherapy pateints were 20.83%,8.00% and 0.00%,respectively,and which in patients treated with cryotherapy was lower than that in patients treated with LEEP(P<0.05).Conclusions: The cervical cryotherapy treatment does not have scar,change the cervical tube length,adhesion and contracture,and affect fertility function,which is suitable for young childless or retaining fertility requirements patients.
-
Key words:
- cervical lesion /
- cryotherapy /
- laser /
- loop electrosurgical excision procedure
-
[1] MUTAMBARA J,MUTANDWA P,MAHAPA M,et al.Knowledge,attitudes and practices of cervical cancer screening among women attend traditional churches in Zimbawe[J].J Cancer Res Pract,2017,4(2):53. [2] WANG T.Review of research on the prevention of HPV infection and cervical cancer[J].Infect Intern,2016,5(2):39. [3] 曾琬琴,殷霞,狄文.宫颈癌的免疫治疗进展[J].国际妇产科学杂志,2017,44(6):681. [4] LIU X,FENG A,CUI Y,et al.Prevention of human papillomavirus (HPV) infection and cervical cancer in China:how does HPV vaccination bring about benefits to Chinese women?[J].Bio Sci Trends,2013,7(4):159. [5] ZHU M,HE Y,BAAK JP,et al.Factors that influence persistence or recurrence of high-grade squamous intraepithelial lesion with positive margins after the loop electrosurgical excision procedure:a retrospective study[J].BMC Cancer,2015,15:744. [6] SANTESSO N,SCHÜNEMANN H,BLUMENTHAL P,et al.World Health Organization Guidelines:use of cryotherapy for cervical intraepithelial neoplasia[J].Int J Gynecol Obstet,2012,118(2):97. [7] BAUST JG,GAGE AA,CLARKE D,et al.Cryosurgery-a putative approach to molecular-based optimization[J].Cryobiology,2004,48(2):190. [8] SCHIFFMAN M,CASTLE PE,JERONIMO J,et al.Human papillomavirus and cervical cancer[J].Lancet,2003,370(9590):890. [9] LUCIANI S,GONZALES M,MUNOZ S,et al.Effectiveness of cryotherapy treatment for cervical intraepithelial neoplasia[J].Int J Gynecol Obstet,2008,101(2):172. [10] CECCHINI S,CIATTO S,LOSSA A,et al.Re:Cervical intraepithelial neoplasia outcomes after treatment:long-term follow-up from the British Columbia Cohort Study[J].J Natl Cancer Inst,2009,101(20):1429. [11] CHUMWORATHAYI B,THINKHAMROP J,BLUMENTHAL PD,et al.Cryotherapy for HPV clearance in with biopsy-confirmed cervical low-grade squamous intraepithelial lesions[J].Int J Gynecol Obstet,2010,108(2):119. -
点击查看大图
计量
- 文章访问数: 4380
- HTML全文浏览量: 711
- PDF下载量: 28
- 被引次数: 0
下载:
