目的 评估CO₂激光治疗宫颈上皮内瘤变Ⅱ级（CIN2）病例的疗效。方法 收集2021年11月至2023年10月在本院行CO2激光治疗的92例CIN2患者的临床资料, 采用液基细胞学检查（LCT）和人乳头状瘤病毒（HPV）联合筛查随访,随访6~12个月, 任一结果异常者转诊阴道镜检查, 必要时行病理活组织检查（活检）观察鳞状上皮内病变情况。结果 92例CIN2患者中, 年龄25~45岁、有人工流产史、性伴侣人数3个及以上、因发现宫颈病变就诊者占比较多,患者均未生育。所有患者就诊时均发现HPV阳性, 20.65%患者报告HPV16阳性, HPV18阳性者占比1.09%, HPV其他12种阳性占60.87%, HPV16阳性伴其他12种阳性占17.39%。79例患者随访6个月后总HPV+LCT均阴率为74.68%（59/79）,LCT和HPV阴转率分别为92.41%（73/79）和74.68%（59/79）。所有患者术后12个月LCT均转阴。29例患者在术后12个月均无病变持续或病变发展。25岁以下患者术后6个月及12个月HPV持续率最低, 45~55岁患者术后HPV持续率最高,且多发生HPV16阳性及合并其他HPV亚型阳性的情况。结论 CO₂激光治疗可提高患者术后HPV与LCT阴转率, 所有患者术后6个月及12个月随访均无病变加重,且可明显改善年轻患者HPV感染情况。对于有生育要求且具备适应证的CIN2患者, 应积极采取CO₂激光治疗以获得更高健康收益。

Objective To evaluate the therapeutic efficacy of CO₂ laser treatment in cervical intraepithelial neoplasia grade 2（CIN2）patients. Methods We retrospectively analyzed data from 92 CIN2 patients who underwent CO₂ laser therapy at the institution from November 2021 to October 2023. Postoperative followed-up for 6-12 months, screening with liquid-based cytopathology test（LCT）and high-risk human papilloma virus（HPV）testing. Patients with abnormal results in either test were referred for colposcopy, with biopsy performed to evaluate residual or recurrent squamous intraepithelial lesions. Results Among total of 92 patients, most patients aged 25-45 years old, with a history of induced abortion, had three or more sexual partners, and visited hospital due to cervical lesions, and none of the patients gave birth. All patients were found to be HPV positive at hospital visits, with 20. 65% of HPV16 positive, 1. 09% of HPV18 positive, 60. 87% of other 12 kinds HPV positive, while HPV16 positive with other 12 kinds accounted for 17. 39%. Among the 79 patients after 6-month follow-up, the dual-negative conversion rate（HPV+LCT）was 74. 68%（59/79）, with LCT and HPV negative rates reaching 92. 41%（73/79）and 74. 68%（59/79）, respectively. After 12-month follow-up, all patients achieved LCT negativity, 29 patients with no documented lesion persistence or disease progression. Notably, patients aged <25 years exhibited the lowest postoperative HPV persistence rates between 6- to 12-month follow-up, whereas those aged 45-55 years demonstrated the highest persistence rates, frequently associated with HPV16 positivity or co-infection with other HPV subtypes. Conclusions CO₂ laser therapy significantly increases postoperative negative conversion rates for HPV and LCT. No lesion progression was observed in patients between 6- to 12-month follow-ups. The therapy also notably improves HPV clearance in younger patients. For patients with CIN2 who have fertility requirements and meet the indications, CO2 laser therapy should be actively adopted to achieve greater health benefits.