目的 本研究旨在比较二氧化碳（CO₂）激光与宫颈环形电切术（LEEP）治疗有生育需求的宫颈高级别上皮内瘤变2级（CIN2）患者的围手术期指标、疗效及影响因素。 方法 回顾性纳入2021年11月至2024年6月期间经病理确诊的267例CIN2患者，其中154例接受CO₂激光治疗，113例接受LEEP治疗。比较两组患者的围手术期指标、术后6个月及12个月的病灶缓解率、高危型人乳头瘤病毒（HR-HPV）转阴率和宫颈细胞学（TCT）转阴率，并按年龄和人乳头瘤病毒（HPV）感染类型进行分层分析，同时采用多因素logistic回归分析影响疗效的因素。 结果 CO₂激光组在手术时间、术中出血量、术后出血时间、恢复时间、并发症发生率及治疗费用方面均显著优于LEEP组（P < 0.05）。然而，在术后6个月和12个月，LEEP组的病灶缓解率均显著高于CO₂激光组（79.65% vs. 68.83%，P = 0.045； 78.76% vs. 66.23%，P = 0.022），且术后6个月的HPV总转阴率也更高（80.53% vs. 70.13%，P = 0.047），但至术后12个月时两组HPV转阴率差异无统计学意义。分层分析显示，LEEP在25 ~ 45岁年龄段患者中早期疗效优势更明显。多因素分析证实，HPV多重感染是影响术后病灶缓解的独立危险因素，而治疗方式本身并非独立影响因素。 结论 CO₂激光在微创性、恢复速度和成本控制方面优势突出，而LEEP术在育龄期患者中能实现更快的早期病灶清除。临床决策应综合考虑患者年龄、HPV感染状态及个体化需求，HPV多重感染患者需加强术后监测。未来需开展长期随访的前瞻性研究以验证结论。

Objective This study was designed to compare the peri-operative indicators， efficacy， and influencing factors between carbon dioxide （CO₂） laser therapy and loop electrosurgical excision procedure （LEEP） in treating cervical intraepithelial neoplasia grade 2 （CIN2） patients with fertility requirements. Methods We retrospectively included 267 patients with pathologically-confirmed CIN2 from November 2021 to June 2024. Among them， 154 patients received CO₂ laser treatment， and 113 patients received LEEP treatment. We compared the peri-operative indicators， lesion remission rates at 6 and 12 months after surgery， high-risk human papillomavirus （HR-HPV） clearance rates， and cervical cytology （TCT） clearance rates between the two groups. Stratified analyses were carried out according to age and human papillomavirus （HPV） infection type， and multivariate logistic regression was employed to analyze the factors influencing the efficacy. Results The CO₂ laser group exhibited significant advantages over the LEEP group in aspects such as operative time， intraoperative blood loss， postoperative bleeding duration， recovery time， complication rates， and treatment costs （P < 0.05）. Nevertheless， at 6 and 12 months after the operation， the lesion remission rates were notably higher in the LEEP group when compared to the CO₂ laser group （79.65% vs. 68.83%， P = 0.045； 78.76% vs. 66.23%， P = 0.022）. Moreover， the overall HPV clearance rate at 6 months after the operation was higher in the LEEP group （80.53% vs. 70.13%， P = 0.047）， yet no significant difference was detected between the two groups at 12 months after the operation. Stratified analysis indicated that LEEP showed a more prominent early-efficacy advantage in patients aged 25 - 45 years. Multivariate analysis verified that multiple human papillomavirus （HPV） infections were an independent risk factor influencing postoperative lesion remission， whereas the treatment modality itself was not an independent influencing factor. Conclusions CO₂ laser therapy presents significant advantages in terms of minimal invasiveness， rapid recovery， and effective cost control. In contrast， LEEP can lead to quicker early clearance of lesions in patients of reproductive age. Clinical decision-making ought to comprehensively take into account the patient's age， HPV infection status， and individualized requirements. Patients with multiple HPV infections need intensified postoperative monitoring. Future prospective studies with long-term follow-up are necessary to validate these conclusions.