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子宫颈环形电切术与CO2激光汽化治疗宫颈上皮内瘤变2级的价值医学

孙璐璐,  曹冬焱,  杨佳欣,  卞美璐,  魏丽慧,  杨丽,  成宁海,  杨毅,  王友芳,  程雪梅,  虎丽军,  陈杰,  郎景和,  沈铿

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文章导航 > 协和医学杂志  > 2011 >  2(2): 129-133
孙璐璐, 曹冬焱, 杨佳欣, 卞美璐, 魏丽慧, 杨丽, 成宁海, 杨毅, 王友芳, 程雪梅, 虎丽军, 陈杰, 郎景和, 沈铿. 子宫颈环形电切术与CO2激光汽化治疗宫颈上皮内瘤变2级的价值医学[J]. 协和医学杂志, 2011, 2(2): 129-133. doi: 10.3969/j.issn.1674-9081.2011.02.008
引用本文: 孙璐璐, 曹冬焱, 杨佳欣, 卞美璐, 魏丽慧, 杨丽, 成宁海, 杨毅, 王友芳, 程雪梅, 虎丽军, 陈杰, 郎景和, 沈铿. 子宫颈环形电切术与CO2激光汽化治疗宫颈上皮内瘤变2级的价值医学[J]. 协和医学杂志, 2011, 2(2): 129-133. doi: 10.3969/j.issn.1674-9081.2011.02.008
shu
Lu-lu SUN, Dong-yan CAO, Jia-xin YANG, Mei-lu BIAN, Li-hui WEI, Li YANG, Ning-hai CHENG, Yi YANG, You-fang WANG, Xue-mei CHENG, Li-jun HU, Jie CHEN, Jing-he LANG, Keng SHEN. Value-based Medicine of Loop Electrosurgical Excision Procedure and CO2 Laser Vaporization for Cervical Intraepithelial Neoplasia 2[J]. Medical Journal of Peking Union Medical College Hospital, 2011, 2(2): 129-133. doi: 10.3969/j.issn.1674-9081.2011.02.008
Citation: Lu-lu SUN, Dong-yan CAO, Jia-xin YANG, Mei-lu BIAN, Li-hui WEI, Li YANG, Ning-hai CHENG, Yi YANG, You-fang WANG, Xue-mei CHENG, Li-jun HU, Jie CHEN, Jing-he LANG, Keng SHEN. Value-based Medicine of Loop Electrosurgical Excision Procedure and CO2 Laser Vaporization for Cervical Intraepithelial Neoplasia 2[J]. Medical Journal of Peking Union Medical College Hospital, 2011, 2(2): 129-133. doi: 10.3969/j.issn.1674-9081.2011.02.008
shu

子宫颈环形电切术与CO2激光汽化治疗宫颈上皮内瘤变2级的价值医学

doi: 10.3969/j.issn.1674-9081.2011.02.008
  • 1.

    中国医学科学院 北京协和医学院 北京协和医院 妇产科, 北京 100730

  • 2.

    中国医学科学院 北京协和医学院 北京协和医院 病理科, 北京 100730

  • 3.

    中日友好医院妇产科, 北京 100029

  • 4.

    北京大学 人民医院妇产科, 北京 100044

  • 5.

    北京市普仁医院妇产科, 北京 100062

基金项目: 

北京市科技计划项目 D0906008040391

国家“十一五”重点支撑项目 2008BAI57B00

详细信息
    通讯作者:

    沈铿 电话:010-65296218, E-mail:shenkeng@vip.sina.com

  • 中图分类号: R711.74;R713

Value-based Medicine of Loop Electrosurgical Excision Procedure and CO2 Laser Vaporization for Cervical Intraepithelial Neoplasia 2

  • 1.

    Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 3.

    Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China

  • 4.

    Department of Obstetrics and Gynecology, People's Hospital of Peking University, Beijing 100044, China

  • 5.

    Department of Obstetrics and Gynecology, Beijing Puren Hospital, Beijing 100062, China

More Information

    摘要
  • 摘要:   目的  多中心研究评价子宫颈环形电切术(loop electrosurgical excision procedure, LEEP)与CO2激光汽化治疗宫颈上皮内瘤变(cervical intraepithelial neoplasia, CIN)2级的疗效、费用及术后生活质量。  方法  选取宫颈活检病理证实的CIN2患者338例, 分别采用LEEP术和CO2激光汽化治疗, 术后3、6及12个月进行随访, 记录疗效、并发症及费用, 术后12个月填写生活质量问卷。  结果  LEEP组195例患者, 病变缓解174例(89.2%)、病变复发7例(3.6%); 激光组143例患者, 病变缓解124例(86.7%)、病变复发1例(0.70%), 两组疗效比较差异无统计学意义(P > 0.05)。LEEP组术后痊愈时间、手术次数、术中出血量及平均治疗费用与激光组比较差异有统计学意义(P < 0.05), 两组术后生活质量评分差异无统计学意义(P > 0.05)。  结论  LEEP与CO2激光汽化治疗CIN2是安全而有效的方法, 治疗前疾病状态的准确评估及术后规范随访对CIN2的治疗具有重要作用。同时, 妇科医生应加强对患者生活质量的重视。
    Abstract:   Objective  To compare the effectiveness, cost, and quality of life between loop electrosurgical excision procedure(LEEP)and CO2 laser vaporization in treating cervical intraepithelial neoplasia 2(CIN2).  Methods  Totally 338 women with colposcopic-histopathologically confirmed CIN2 were enrolled in this study, of whom 195 underwent LEEP(LEEP group)and 143 underwent CO2 laser vaporization(laser group).They were followed up 3, 6, and 12 months after treatment.A questionnaire of EORTC QLQ-C30 and QLQ-CX24 were filled out at 12 months follow-up.  Results  In LEEP group, CIN was cured in 174 patients(89.2%)and relapsed in 7(3.6%).In laser group, CIN was cured in 124 patients(86.7%)and relapsed in 1 patient(0.70%)(both P > 0.05).The recovery time, number of operation, bleeding volume, and costs were significantly different between these two groups(P < 0.05).Women treated with LEEP showed relatively identical quality of life compared with those treated with CO2 laser vaporization.  Conclusions  Both LEEP and CO2 laser vaporization are effective and reliable for the treatment of CIN2, while pre-operative evaluations and post-operative follow-up are essential.Attention should also be paid to the post-operative quality of life.
    • HTML全文

  • 表  1  两组患者临床疗效比较

    组别 总例数 病变缓解
    [n(%)]    		 病变持续
    [n(%)]    		 病变复发
    [n(%)]
    激光组 143 124 (86. 7) 18 (12. 6) 1 (0. 7)
    LEEP组 195 174 (89. 2)* 14 (7. 2)* 7 (3. 6)*
    LEEP:子宫颈环形电切术; 与激光组比较, *P＜0. 05
    下载: 导出CSV

    表  2  两组患者术后生活质量比较

    生活质量 激光组
    (n=143)    		 LEEP组*
    (n=195)
    EORTCQLQ-C30
       总健康状况/生活质量 63.2 65.6
       体能 79.7 78.8
       角色 81.1 82.0
       情感 79.0 78.3
       认知能力 81.3 80.3
       社交能力 84.1 85.5
       疲劳 29.6 30.5
       恶心/呕吐 6.4 6.2
       疼痛 15.6 16.5
       呼吸困难 17.0 17.2
       失眠 16.8 16.5
       食欲不振 14.2 14.3
       便秘 14.7 15.3
       腹泻 7.1 7.2
       经济困难 15.2 17.5
    EORTCQLQ-CX24 29.6 30.5
       症状体验 6.2 8.5
       自身形象 17.5 20.0
       性功能/阴道功能 16.3 18.4
       淋巴水肿 10.0 12.3
       周围神经病 11.5 12.1
       绝经症状 12.2 14.0
       担忧性生活 15.3 18.2
       性活动 23.0 23.5
       享受性生活 29.3 30.7
    EORTC:欧洲癌症研究和治疗机构; QLQ -C 30:肿瘤患者一般生活质量问卷(30项); QLQ CX 24:宫颈癌患者生活质量问卷; LEEP:同表 1; 与激光组比较, *P＜0. 05
    下载: 导出CSV
    • 参考文献(10)
  • [1] 李娟清, 石一复.子宫颈上皮内瘤变的诊治[J].实用肿瘤杂志, 2007, 1:9-10. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=syzlzz200701004
    [2] 虎丽军, 王友芳, 王勉镜, 等.CO2激光治疗合并HPV感染的宫颈糜烂及宫颈上皮内瘤变的临床研究[J].中国激光医学杂志, 2003, 3:20-21. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgjgyx200303013
    [3] Kyrgiou M, Koliopoulos G, Martin-Hirsch P, et al.Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions:systematic review and metaanalysis[J].Lancet, 2006, 367:489-498. doi:  10.1016/S0140-6736(06)68181-6
    [4] Kazandi M, Oztekin K, Kazandi AC, et al.Evaluation of LOOP electrosurgical excisional procedure:case series[J]. EurJ Gyneacol Oncol, 2010, 31:562-563. http://europepmc.org/abstract/MED/21061801
    [5] 黄莉霞, 杨伶俐, 杨慧琳, 等.LEEP治疗CIN148例临床分析[J].中国妇幼保健, 2009, 32:13-14. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgfybj200932014
    [6] Liu Y, Li C, Wang J, et al.Repeatlow-grade squamous intraepithelial cytology with unsatisfactory colposcopy treated by the loop electrosurgical excision procedure:a retrospective study[J].Eur J Gyneacol Oncol, 2010, 31:632- 635. http://europepmc.org/abstract/MED/21319505
    [7] Wright TC Jr, Cox JT, Massad LS, et al.2001 consensus guidelines for the management of women with cervical intraepithelial neoplasia [J].Am J Obstet Gynecol, 2003, 189:295-304. doi:  10.1067/mob.2003.633
    [8] Paraskevaidis E, Arbyn M, Sotiriadis A, et al.The role of HPV DNA testing in the follow-up period after treatment for CIN:a systematic review of the literature[J].Cancer Treat Rev, 2004, 30:205-211. doi:  10.1016/j.ctrv.2003.07.008
    [9] Wang SS, Sherman ME, Hildesheim A, et al.Cervicalade nocarcinoma and squamous cell carcinoma incidence trends among white women and black women in the United States for 1976-2000 [J].Cancer, 2004, 100:1035-1044. doi:  10.1002/cncr.20064
    [10] Wright TC Jr, Massad LS, Dunton CJ, et al.2006 consensus guide lines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ[J].Am J Obstet Gynecol, 2007, 197:340-345. doi:  10.1016/j.ajog.2007.07.050
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  • 收稿日期:  2011-01-15
  • 刊出日期:  2011-04-30

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