Sangkarat Suthi, Ruengkhachorn Irene, Benjapibal Mongkol, Laiwejpithaya Somsak, Wongthiraporn Weerasak, Rattanachaiyanont Manee
Gynecologic Oncology Division, 2Gynecologic Cytology Unit, 3Gynecologic Endocrinology Unit, 4Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand E-mail :
Asian Pac J Cancer Prev. 2014;15(2):1035-9. doi: 10.7314/apjcp.2014.15.2.1035.
To evaluate the operative, oncologic and obstetric outcomes of the loop electrosurgical excision procedure (LEEP) in cases with cervical neoplasia.
A retrospective cohort study was conducted on patients who were suspected of cervical neoplasia and therefore undergoing LEEP at Siriraj Hospital, Mahidol University, Thailand, during 1995-2000. Outcome measures included operative complications in 407 LEEP patients and long-term outcomes in the 248 patients with cervical intraepithelial neoplasia (CIN) who were treated with only LEEP.
There were 407 patients undergoing LEEP; their mean age was 39.7±10.5 years. The histopathology of LEEP specimens revealed that 89 patients (21.9%) had lesions ≤CIN I, 295 patients (72.5%) had CIN II or III, and 23 patients (5.6%) had invasive lesions. Operative complications were found in 15 patients and included bleeding (n=9), and infection (n=7). After diagnostic LEEP, 133 patients underwent hysterectomy as the definite treatment for cervical neoplasia. Of 248 CIN patients who had LEEP only, seven (2.8%) had suffered recurrence after a median of 16 (range 6-93) months; one had CIN I, one had CIN II, and five had CIN III. All of these recurrent patients achieved remission on surgical treatment with re-LEEP (n=6) or simple hysterectomy (n=1). A significant factor affecting recurrent disease was the LEEP margin involved with the lesion (p=0.05). Kaplan-Meier analysis showed 5-year and 10-year disease-free survival (DFS) estimates of 99.9%. Twelve patients became pregnant a total of 14 times, resulting in 12 term deliveries and two miscarriages - one of which was due to an incompetent cervix.
LEEP for patients with cervical neoplasia delivers favorable surgical, oncologic and obstetric outcomes.
评估宫颈病变患者行环形电切术（LEEP）的手术、肿瘤学及产科结局。
对1995 - 2000年期间在泰国玛希隆大学诗里拉吉医院疑似宫颈病变并接受LEEP治疗的患者进行回顾性队列研究。观察指标包括407例行LEEP患者的手术并发症，以及248例仅接受LEEP治疗的宫颈上皮内瘤变（CIN）患者的长期结局。
407例患者接受了LEEP治疗，平均年龄为39.7±10.5岁。LEEP标本的组织病理学检查显示，89例（21.9%）患者病变≤CIN I，295例（72.5%）患者为CIN II或III，23例（5.6%）患者有浸润性病变。15例患者出现手术并发症，包括出血（9例）和感染（7例）。诊断性LEEP后，133例患者接受子宫切除术作为宫颈病变的确定性治疗。在248例仅行LEEP的CIN患者中，7例（2.8%）在中位时间16个月（范围6 - 93个月）后复发；1例为CIN I，1例为CIN II，5例为CIN III。所有这些复发患者经再次LEEP（6例）或单纯子宫切除术（1例）手术治疗后均缓解。影响疾病复发的一个重要因素是LEEP切缘累及病变（p = 0.05）。Kaplan - Meier分析显示5年和10年无病生存率（DFS）估计值为99.9%。12例患者共怀孕14次，分娩12次，流产2次 - 其中1次流产是由于宫颈机能不全。
宫颈病变患者行LEEP可获得良好的手术、肿瘤学及产科结局。
