高危型HPV监测评估宫颈电环切术治疗宫颈上皮内瘤样病变  

High-risk human papillomavirus detection for evaluation of the therapeutic effect of loop electrosurgical excisional procedure on cervical intraepithelial neoplasia

作　　者：耿晓星[1] 马荣[1] 朱镭[1] 高庆玉[1] 

机构地区：[1]哈尔滨医科大学附属肿瘤医院妇科,哈尔滨150086

出　　处：《肿瘤》2006年第9期836-838,共3页Tumor

基　　金：黑龙江省科技厅自然科学基金资助项目(编号:D0324)

摘　　要：目的：探讨宫颈电圈环行切除术（LEEP）治疗宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）疗效，特别是高危型入乳头瘤病毒感染（HPV）是否消失，以此评估该治疗方法对CIN治疗的有效性。方法：对56例超薄液基细胞学（TCT）涂片异常并经阴道镜检病变小于2cm，组织学检查证实为CIN1～3的妇女实行了宫颈电圈环行切除术（LEEP），治疗后3个月随诊时再次行TCT检查并采用HC-2法检测高危型HPV。结果：①CIN1组HPV转阴率为72．5％（29／40），病变残留（切缘阳性）率为5％（2／40），病变残留与HPV持续阳性成正比。②CIN2～3组HPV转阴率为44％（7／16），病变残留率为31％（5／16），病变残留与HPV持续阳性成正比。③CIN1组治疗后HPV阴转率及病灶彻底切除率均高于CIN2～3组，经统计学处理有显著意义。结论：①高危型HPV感染率与CIN程度成正比，在CIN2～3中高于CIN1。②LEEP不仅可以有效的治疗CIN1，而且可以使其伴行的HPV感染消失；③LEEP治疗部分CIN2～3尚不够充分，应加大宫颈组织的切除范围和深度。④LEEP治疗后残留病变和HPV持续阳性密切相关；⑤TCT和HPV检测不仅可以评价宫颈疾病治疗效果而且可以作为CIN治疗后追踪随访的有效手段。Objective：To explore the therapeutic efficacy of loop electrosurgical excisional procedure （LEEP） for cervical intraepithelial neoplasia （CIN） by detecting high-risk human papillomavirus （HPV） infection. Methods： LEEP was performed on 56 women with CIN 1-3 confirmed by histological examination. Thinprep cytologic test （TCT） showed that they had abnormal smear and colposcopy guided biopsy demonstrated that the lesions was less than 2 cm. Three months later they received the second TCT examination and high-risk HPV detection by HybridCapture 2 method. Results：① In CIN 1 group the negative rate of HPV infection was 72.5 % （29/40）and the residual rate was 5 % （2/40）. The residual rate positively correlated with HPV persistent infection. ②In CIN 2-3 group, the negative rate of HPV infection was 44% （7/16） and the residual rate was 31% （5/16）. The residual rate positively correlated with HPV persistent infection. ③HPV negative rate and focus resection rate in CIN 1 group was significantly higher than that in CIN 2-3 group. The difference was significant. Conclusions：① High-risk HPV infection positively correlated with the pathological degree of CIN. The infection rate was higher in C1N 2-3 group than that in CIN 1 group. ②LEEP was effective in the treatment of CIN 1 accompanied with disappearance of HPV infection. ③The therapeutic efficacy of LEEP for CIN 2-3 was not satisfying. A wider and deeper excision of cervical tissue was necessary. ④The resid ual rate had close correlation with HPV infection after LEEP treatment. OTCT and HPV examination could be evaluated as possible predictors of therapeutic efficacy and prognosis of patients with cervical disease.

关 键 词：宫颈上皮内瘤样病变 乳头状瘤病毒 入 乳头状瘤病毒感染 宫颈电-圈环行切除术 

分 类 号：R737.33[医药卫生—肿瘤] R730.56[医药卫生—临床医学]