宫颈电圈切除术对重度宫颈上皮内瘤变的诊疗价值及高危型HPV检测的临床意义  

Value of loop electrosurgical excision procedure and high-risk human papillomavirus testing for high-grade cervical intraepithelial neoplasia

作　　者：刘凤英[1] 徐晓明[1] 李婷[1] 刘毅智[1] 吴宜林[1] 

机构地区：[1]中南大学湘雅二医院妇科,长沙410011

出　　处：《中国肿瘤临床与康复》2005年第1期3-6,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨宫颈电圈切除术(LEEP)对重度宫颈上皮内瘤变(CINⅡ～Ⅲ)的诊疗价值,研究高危型人乳头瘤病毒(HPV)在重度CIN中的感染情况及对LEEP术预后的影响。方法对112例重度CIN患者行阴道镜活检及LEEP术治疗,并同时行高危型HPV的PCR检测,对其疗效及预后进行分析。结果在112例重度CIN患者中,CINⅡ级67例,CINⅢ级(包括原位癌)45例。LEEP术后随访,治愈98例,治愈率达87.5%;发现病变残留者14例(12.5%),复发者4例(3.6%)。在所有患者中,92例高危型HPV检测阳性,总感染率为82.1%。CINⅢ级患者HPV阳性率(93.3%)较CINⅡ级患者(74.6%)显著升高(P<0.05)。高危型HPV阳性组LEEP术后病变残留率或复发率与HPV阴性组比较,差异无显著性(10.9%比20.0%,或4.3%比0;P>0.05)。因CIN残留或复发而再次行LEEP术的13例患者中,检测到12例(92.3%)仍有高危型HPV感染。结论LEEP术是诊断和治疗重度CIN的有效且理想的方法。高危型HPV与重度CIN的发生有关。术前高危型HPV阳性与否似乎与LEEP术预后无关。Objectives To determine the value of loop electrosurgical excision procedure (LEEP) for the management of high-grade cervical intraepithelial neoplasia (CINⅡ-Ⅲ) and to evaluate whether high-risk human papillomavirus (HR-HPV) infection is associated with the prognosis of the patients who underwent LEEP for high-grade CIN.Methods The study was conducted on 112 patients who underwent cervical biopsy by colposcopy and LEEP for high-grade CIN, and HR-HPV testing was performed by PCR at the time of conization.Results Of 112 patients who underwent LEEP, 67 were CIN Ⅱ and 45 were CIN Ⅲ (including CIS). The overall cure rate was 87.5%.Fourteen residual lesions (12.5%) and 4 recurrences (3.6%) were observed. Of these patients, 92 ((82.1%)) were positive for HR-HPV testing. The positive rate in CIN Ⅲ (93.3%) was significantly higher than that in CIN Ⅱ (74.6%,P<0.05).Any statistically significant difference in residual disease or recurrence between the two groups was not observed: HR-HPV positive or negative rate was 10.9% vs 20.0%, or 4.3% vs 0((P>0.05)).Of the 13 patients who underwent the second LEEP for residual disease or recurrence, 12((92.3%))also had persistent HR-HPV infection.Conclusions LEEP is a kind of effective and safe method for the diagnosis and treatment of high-grade CIN. HR-HPV may play an important role in the occurrence of high-grade CIN. Pretreatment HR-HPV testing seems to have no predictive value for the prognosis of the patients who undergo LEEP for high-grade CIN. Posttreatment HR-HPV testing may be useful in the follow-up of patients after conization. Loopelec

关 键 词：宫颈电圈切除术 宫颈上皮内瘤变 人乳头瘤病毒 癌前病变 

分 类 号：R737.33[医药卫生—肿瘤]