光动力疗法与子宫颈环形电切术治疗宫颈上皮内瘤变2级的疗效对比

doi:10.11958/20231056

天津医药 ›› 2024, Vol. 52 ›› Issue (5): 509-513.doi: 10.11958/20231056

光动力疗法与子宫颈环形电切术治疗宫颈上皮内瘤变2级的疗效对比

孙俊杰¹(), 郭素杰¹, 李洪林¹, 岳莹莹¹, 王兴芬²

1 天津医科大学第二医院妇科（邮编300211），2病理科

收稿日期:2023-07-16 修回日期:2023-11-29 出版日期:2024-05-15 发布日期:2024-05-09
作者简介:孙俊杰（1979），女，主任医师，主要从事妇科肿瘤和子宫内膜异位症方面研究。E-mail：sunjunjie1979525@sina.com
基金资助:
天津市卫生局科技基金资助项目(2013KZ108)

Comparative study on the efficacy of photodynamic therapy and loop electrosurgical excision procedure in the treatment of grade 2 cervical intraepithelial neoplasia

SUN Junjie¹(), GUO Sujie¹, LI Honglin¹, YUE Yingying¹, WANG Xingfen²

1 Department of Gynecology, 2 Department of Pathology, the Second Hospital of Tianjin Medical University, Tianjin 300211, China

Received:2023-07-16 Revised:2023-11-29 Published:2024-05-15 Online:2024-05-09

孙俊杰, 郭素杰, 李洪林, 岳莹莹, 王兴芬. 光动力疗法与子宫颈环形电切术治疗宫颈上皮内瘤变2级的疗效对比[J]. 天津医药, 2024, 52(5): 509-513.

SUN Junjie, GUO Sujie, LI Honglin, YUE Yingying, WANG Xingfen. Comparative study on the efficacy of photodynamic therapy and loop electrosurgical excision procedure in the treatment of grade 2 cervical intraepithelial neoplasia[J]. Tianjin Medical Journal, 2024, 52(5): 509-513.

摘要/Abstract

摘要：

目的评价光动力疗法与宫颈环形电切术（LEEP）治疗宫颈上皮内瘤变2级（CIN2）的疗效及不良事件的发生情况。方法 40例CIN2级患者依治疗方案不同分为光动力组20例和LEEP组20例，于治疗后3、6及12个月进行随访，比较2组患者高危型HPV病毒（HR-HPV）、阴道微生态、阴道镜检查和宫颈活检情况，记录不良事件发生情况。结果 2组间患者治疗后3个月的病变逆转、病变残留及病变进展构成差异无统计学意义。光动力组治疗后6个月时1例复发者和LEEP组治疗后12个月时1例复发者的宫颈活检病理均为CIN1级。2组患者治疗后3、6及12个月HR-HPV转阴率、正常阴道微生态比例差异无统计学意义。光动力组治疗后3、6、12个月患者的正常阴道微生态比例呈依次增高的趋势。在治疗过程中，光动力组患者疼痛能忍受，LEEP组疼痛明显并伴有出血；2组治疗后均有阴道分泌物增多、下腹坠痛，但LEEP组有宫颈局部瘢痕形成并有1例出现阴道出血。结论光动力疗法治疗CIN2效果较好，HR-HPV转阴率高，对宫颈几乎无损伤，尤其适用于有生育要求的患者。

关键词: 宫颈上皮内瘤样病变, 光动力疗法, 宫颈环形电切术

Abstract:

Objective To evaluate the efficacy and incidence of adverse events of photodynamic therapy and loop electrosurgical excision procedure (LEEP) in the treatment of grade 2 cervical intraepithelial neoplasia (CIN2). Methods Forty CIN2 patients were divided into the photodynamic group (20 cases) and LEEP group (20 cases) according to different treatment options. Follow ups were conducted at 3, 6 and 12 months after treatment. High-risk HPV virus (HR-HPV), vaginal microbiota, colposcopy examination and cervical biopsy results were compared between the two groups. Adverse events were recorded. Results There was no significant difference in the composition of lesion reversal, residual lesions and progression after 3 months of treatment between the two groups of patients. After 6 months of treatment, one case relapsed in the photodynamic group, and 12 months after treatment one case relapsed in the LEEP group. Both cases of cervical biopsy pathology were CIN1 grade. There were no significant differences in the conversion rate of HR-HPV and the proportion of normal vaginal microbiota between the two groups of patients at 3, 6, and 12 months after treatment. The proportion of normal vaginal microbiota in the photodynamic group increased sequentially at 12 months after treatment compared to 3 and 6 months after treatment. During the photodynamic treatment, the pain was tolerable in the photodynamic group, while in the LEEP group, the pain was obviously accompanied by bleeding. After treatment, patients in both groups had increased vaginal discharge and lower abdominal pain, but in the LEEP group, local cervical scars formed and one case experienced vaginal bleeding. Conclusion Photodynamic therapy is effective on treating CIN2, with a high negative conversion rate of HR-HPV and almost no damage to the cervix, especially suitable for patients with fertility requirements.

Key words: cervical intraepithelial neoplasia, photodynamic therapy, cervical circular electrocautery

中图分类号:

R739.9

图/表 6

表1 2组间一般情况比较

Tab.1 Comparison of general clinical data between two groups

组别	n	年龄/岁	吸烟	避孕套避孕
LEEP组	20	32.85±5.60	3（15.0）	15（75.0）
光动力组	20	31.45±5.17	2（10.0）	13（65.0）
t或χ²		0.822	0.000	0.119

表2 2组治疗后3个月治疗效果比较 [例（%）]

Tab.2 Comparison of treatment effects 3 months after treatment etween two groups of patients

组别	n	病变逆转	病变残留	病变进展
LEEP组	20	19（95.0）	1（5.0）	0
光动力组	20	17（85.0）	3（15.0）	0
χ²		0.278

图1 2组治疗前和治疗后3个月电子阴道镜下宫颈图片

Fig.1 Cervical images under the instruction of electronic colposcopy before and 3 months after treatment in two groups

图2 2组治疗前和治疗后3个月宫颈活检病理图片

Fig.2 Pathological images of cervical biopsy before and 3 months after treatment in two groups

表3 2组患者治疗后HR-HPV转阴情况比较 [例（%）]

Tab.3 Comparison of HR-HPV negative conversion after treatment between two groups of patients

组别	n	3个月	6个月	12个月	χ²
LEEP组	20	14（70.0）	15（75.0）	15（75.0）	0.125
光动力组	20	13（65.0）	16（80.0）	17（85.0）	1.200
χ²		0.114	0.000	0.156

表4 2组患者治疗后正常阴道微生态情况比较 [例（%）]

Tab.4 Comparison of normal vaginal microbiota after treatment between two groups of patients

组别	n	3个月	6个月	12个月	χ²
LEEP组	20	11（55.0）	12（60.0）	12（60.0）	0.102
光动力组	20	10（50.0）	14（70.0）	16（80.0）	3.956^＊＊
χ²		0.100	0.440	1.071

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光动力疗法与子宫颈环形电切术治疗宫颈上皮内瘤变2级的疗效对比

Comparative study on the efficacy of photodynamic therapy and loop electrosurgical excision procedure in the treatment of grade 2 cervical intraepithelial neoplasia

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