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目的 探讨二氧化碳(CO2)激光治疗宫颈和阴道高级别鳞状上皮内病变(HSIL)的临床效果。方法 回顾性分析2022年2月至2024年2月在北京协和医院进行CO2激光治疗的239例宫颈和阴道HSIL患者的临床资料，包括一般情况、激光治疗前后的液基薄层细胞学检查(TCT)、高危型人乳头瘤病毒(HR-HPV)检测结果、经阴道镜活检的病理报告等。对CO2激光治疗效果进行评价，并采用单因素、多因素Logistic分析CO2激光治疗效果不佳的危险因素。结果 239例HSIL患者中，CO2激光治疗6个月后有效率为69.0%，宫颈HSIL患者有效率为75.4%，阴道HSIL患者有效率为61.5%，宫颈HSIL患者的激光治疗效果显著优于阴道HSIL患者(P<0.05);2次CO2激光治疗后HR-HPV阴性率及TCT正常率均无明显提高。单因素、多因素回归分析提示，年龄增长、病变类型为阴道HSIL是激光治疗效果不佳的危险因素(P<0.05)。结论 CO2激光治疗宫颈和阴道HSIL安全有效，宫颈HSIL的治疗效果更佳。
Abstract：Objective:To investigate the clinical efficacy of carbon dioxide(CO2)laser treatment for high-grade squamous intraepithelial lesions(HSIL)of the cervix and vagina.Methods:A retrospective analysis was conducted on the clinical data of 239patients with cervical and vaginal HSIL who underwent CO2 laser treatment at Peking Union Medical College Hospital from February 2022to February 2024.Data collected included general information,liquid-based cytology tests(TCT),high-risk human papillomavirus(HR-HPV)test results,and colposcopic biopsy pathology reports before and after CO_2laser treatment.The efficacy of CO_2laser treatment was evaluated,and the univariate and multivariate logistic regression analyses were performed to identify risk factors of poor treatment outcomes.Results:Among the 239 HSIL patients,the efficacy rate 6 months after CO_2laser treatment was69.0%.The efficacy rate for cervical HSIL patients was 75.4%,while for vaginal HSIL patients,it was61.5%.The treatment effect was significantly better for cervical HSIL patients compared to vaginal HSIL patients(P<0.05).There was no significant improvement in HR-HPV-negative rates and TCT-normal rates after two sessions of CO2 laser treatment.The univariate and multivariate regression analyses indicated that increasing age and vaginal HSIL were risk factors of poor laser treatment outcomes(P<0.05).Conclusions:CO_2laser treatment for cervical and vaginal HSIL is safe and effective,with better efficacy observed for cervical HSIL.
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基本信息:
中图分类号:R711.7
引用信息:
[1]张姝文,虎丽军,王涛,等.二氧化碳激光治疗宫颈和阴道高级别鳞状上皮内病变的临床效果[J].生殖医学杂志,2025,34(08):1044-1049.
基金信息:
中央高水平医院临床科研业务费(2022-PUMCH-C-015,2022-PUMCH-D-003); 国家重点研发计划(2022YFC2704400)
2024-12-24
2024
2025-02-28
2025-07-09
2025
1
2025-08-15
2025-08-15