宫颈上皮内瘤变物理治疗的研究现状

Research Status of Physical Therapy for Cervical Intraepithelial Neoplasia

摘要: 持续性高危型人乳头瘤病毒(human papillomavirus, HPV)感染被认为是宫颈癌及其癌前病变发生的主要危险因素，因此及时诊断及治疗宫颈上皮内瘤变(cervical intraepithelial neoplasia, CIN)以及防止高危型HPV持续感染是预防病变发展为宫颈癌的主要手段。宫颈CIN治疗方法主要包括物理治疗和切除治疗，前者包括冷冻、激光、热消融、微波以及新兴的聚焦超声、光动力等治疗，后者包括冷刀锥切术、子宫颈环形电切术、激光锥切术等。在我国，切除治疗是宫颈上皮内瘤变的主要治疗手段，但研究表明切除治疗可能会出现术后阴道大量流血流液、颈管粘连等并发症，以及切除术后导致宫颈机能不全引起的胎儿流产或早产率的增加。相较于宫颈切除治疗，物理治疗则可以减少以上近期及远期并发症的发生。根据流行病学研究，目前宫颈CIN发病逐渐年轻化，随着国家提倡晚婚晚育及三胎政策，越来越多的大龄女性可能面临生育的问题。考虑到宫颈病变治疗可能导致的不良妊娠结局，符合物理治疗的、有生育要求的妇女可能会更倾向于选择物理治疗。本文主要阐述近年来宫颈CIN物理治疗的研究现状，以期为患者提供更多治疗选择。

Abstract: Persistent infection with high-risk human papillomavirus (HPV) is recognized as a major risk factor for cervical cancer and its precancerous lesions. Therefore, timely diagnosis, treatment of cervical intraepithelial neoplasia (CIN), and prevention of continued high-risk HPV infection are essential in preventing the progression of cervical cancer. Treatment options for CIN primarily include physical therapy and excisional therapy. Physical therapy encompasses techniques such as cryotherapy, la-ser therapy, thermal ablation, and microwave therapy, as well as emerging treatments like focused ultrasound and photodynamic therapy. Excisional therapy involves procedures such as cold knife conization, loop electrosurgical excision procedure (LEEP), and laser conization. In China, excisional therapy remains the primary treatment approach for cervical intraepithelial neoplasia. However, studies have shown that this method may lead to postoperative complications including significant vaginal bleeding, cervical stenosis, and an increased risk of miscarriage or preterm delivery due to cervical incompetence. In contrast, physical therapy offers potential advantages by minimizing the occurrence of both short-term and long-term complications. Epidemiological studies have revealed a trend of cervical CIN occurring at younger ages. With the promotion of delayed marriage, delayed childbearing, and the implementation of the three-child policy, more mature women may encounter fertility-related concerns. Considering the potential adverse pregnancy outcomes associated with treatment for cervical lesions, women who fulfill the criteria for physical therapy and have fertility aspirations may lean towards this approach. This review primarily elucidates the current research status of physical therapy for CIN, with the aim of providing patients with more treatment options.