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目的 总结应用高频电波刀的电圈切除术 (LEEP)对宫颈病变诊治的指征、病灶切除范围和病理特点。方法 将细胞学和阴道镜检查异常 [宫颈上皮内瘤样变 (CIN)、不典型鳞状细胞(ASCUS) ]的 176例患者 ,分成两部分。对≥CIN2 行锥切术 ,采用LEEP 33例、传统电刀 30例 ;对CIN1和ASCUS行活检术 ,采用LEEP 6 0例、宫颈活检钳 5 3例。LEEP锥切宫颈管组织深 15mm ,宫颈组织深7mm ;活检术切除宫颈、宫颈管组织各深 4mm。结果 LEEP锥切术后 3个月行细胞学检查 ,病变持续存在率 6 .1% ,与传统电刀的 6 .7%相似 ;手术时间 (5 .0± 0 .5 )min ,较传统电刀 (15 .0± 0 .4)min短 ;术中出血与宫颈修复时间均短于传统电刀 (P <0 .0 1)。LEEP活检术后 3个月行细胞学检查 ,病变持续存在率 1.7% ,明显少于宫颈活检钳法 (35 .8% )。其他手术情况相似。结论 LEEP适用于宫颈CIN2 ,3的锥切术和宫颈CIN1、ASCUS的活检术 ,省时、安全 ,可提供完整的病理标本 ,对宫颈微小浸润癌和小局灶癌的诊断率高
Objective To summarize the indications, the extent of resection and the pathological features of cervical lesions by electrosurgical excision (LEEP). Methods 176 patients with cytology and colposcopy abnormalities (cervical intraepithelial neoplasia (CIN), atypical squamous cells (ASCUS)] were divided into two groups. CIN2 conization, using LEEP 33 cases, 30 cases of conventional electric knife; for CIN1 and ASCUS biopsy, using LEEP 60 cases, cervical biopsy forceps 53 cases. LEEP cone cut cervical tissue 15mm deep, deep 7mm cervical tissue; biopsy removed the cervix, cervical tissue 4mm deep. Results LEEP conization at 3 months after cytological examination, the disease continued to exist at a rate of 6.1%, and 6.7% similar to the traditional electric knife; operation time (5.0 ± 0.5) min, compared with the traditional electricity The knife (15.0 ± 0.4) min was shorter; the time of intraoperative bleeding and cervix repair was shorter than that of the traditional electric knife (P <0.01). Cytological examination 3 months after LEEP biopsy, the persistence rate of lesions was 1.7%, significantly less than cervical biopsy forceps (35.8%). Other surgical conditions are similar. Conclusions LEEP is suitable for cervical CIN2, 3 conization and cervical CIN1, ASCUS biopsy, save time and safety, can provide complete pathological specimens, the diagnosis of cervical micro-invasive carcinoma and small focal cancer high