Kietpeerakool C, Srisomboon J, Suprasert P, Phongnarisorn C, Charoenkwan K, Cheewakriangkrai C, Siriaree S, Tantipalakorn C, Pantusart A
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Int J Gynecol Cancer. 2006 May-Jun;16(3):1082-8. doi: 10.1111/j.1525-1438.2006.00518.x.
The objective of this study was to evaluate the treatment outcomes and complications in human immunodeficiency virus (HIV)-infected women undergoing loop electrosurgical excision procedure (LEEP) for cervical neoplasia. The medical record of 60 evaluable HIV-infected women who had abnormal Papanicolaou (Pap) smear and underwent LEEP following colposcopy at Chiang Mai University Hospital between May 1998 and June 2004 was reviewed. Thirty-one (51.7%) had associated genital infection at screening. Twenty-five (41.7%) had opportunistic infection, but only 18 (30.0%) were treated with antiretroviral therapy. The most common abnormal Pap smear was high-grade squamous intraepithelial lesion (46.7%), followed by low-grade squamous intraepithelial lesion (40.0%). Forty (66.7%) women had clear surgical margins after LEEP. Only one (1.7%) woman had severe intraoperative hemorrhage. Early and late postoperative hemorrhage were noted in three (5%) women of each period. Localized infection of the cervix was detected in seven (11.7%) women. Two (3.3%) women developed cervical stenosis at 6 months after LEEP. There was no significant difference in overall complications between HIV-infected women and the control group (P= 0.24). Among 60 HIV-infected women, no statistical difference in the rate of margins involvement (P= 1.00) and complications (P= 0.85) could be demonstrated between HIV-infected women who received antiretroviral therapy and those who did not. Disease-free rate at 6 and 12 months were 97.1% and 88%, respectively. These data demonstrated that LEEP appears to be safe and effective in HIV-infected women.
本研究的目的是评估接受环形电切术（LEEP）治疗宫颈肿瘤的人类免疫缺陷病毒（HIV）感染女性的治疗效果及并发症。回顾了1998年5月至2004年6月期间在清迈大学医院接受阴道镜检查后因巴氏涂片异常而接受LEEP的60例可评估HIV感染女性的病历。31例（51.7%）在筛查时有相关生殖器感染。25例（41.7%）有机会性感染，但仅18例（30.0%）接受了抗逆转录病毒治疗。最常见的巴氏涂片异常是高级别鳞状上皮内病变（46.7%），其次是低级别鳞状上皮内病变（40.0%）。40例（66.7%）女性在LEEP术后切缘清晰。仅1例（1.7%）女性术中发生严重出血。各时期分别有3例（5%）女性出现术后早期和晚期出血。7例（11.7%）女性检测到宫颈局部感染。2例（3.3%）女性在LEEP术后6个月出现宫颈狭窄。HIV感染女性与对照组在总体并发症方面无显著差异（P = 0.24）。在60例HIV感染女性中，接受抗逆转录病毒治疗的HIV感染女性与未接受治疗的女性在切缘受累率（P = 1.00）和并发症（P = 0.85）方面无统计学差异。6个月和12个月时的无病生存率分别为97.1%和88%。这些数据表明，LEEP在HIV感染女性中似乎是安全有效的。
