宫颈环形电切术后切缘状态350例临床分析  

Analysis of Cervical Cutting Edge Status after Loop Electronic Excision Procedure in 350 Patients

作　　者：吴成[1] 王美玲[1] 董颖[1] 吕涛[1] 毕蕙[1] 赵健[1] 李克敏[1] 廖秦平[1] 

机构地区：[1]北京大学第一医院,北京100034

出　　处：《实用妇产科杂志》2011年第3期204-206,共3页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:分析宫颈环形电切术(LEEP)后切缘状态相关因素,评价切缘阳性结果。方法:回顾性分析我院经阴道镜活检诊断为宫颈上皮内瘤变(CIN)Ⅱ～Ⅲ且接受LEEP的患者350例,分析术后切缘阳性及预后的有关因素。结果:①350例患者,切缘阳性89例,其中CINⅡ87例,切缘阳性6例(6.90%);CINⅢ250例,切缘阳性77例(30.80%);宫颈癌13例,切缘阳性6例(46.15%)。②LEEP后行子宫全切除术29例和术后再次行冷刀锥切术1例,共有10例患者CIN病变残留,CIN病变残留率:切缘阴性者14.29%(2/14),切缘阳性者50.00%(8/16)。③对242例患者术后随访,12例CIN病变持续或进展。其中8例为切缘阴性患者,4例为切缘阳性患者(2例进展为宫颈浸润癌)。12例中,4例薄层液基细胞学涂片(TCT)检查阳性;10例人乳头瘤病毒(HPV)检查阳性,其中8例为HPV16亚型持续阳性。④单因素分析表明,切缘阳性与病变严重程度有关(z=4.731,P<0.001),切缘阳性是CIN病变残留的高危因素(r=0.378,P=0.039)。LEEP后TCT检查异常、高危亚型HPV阳性以及同一亚型HPV持续感染是CIN病变持续或进展的高危因素(P≤0.001)。多因素回归分析表明,LEEP后同一亚型HPV持续阳性是CIN病变持续或进展的高危因素(P<0.001)。结论:LEEP后切缘阳性与病变严重程度及CIN病变残留有关,术后同一高危亚型HPV持续阳性应警惕CIN病变持续或进展为宫颈浸润癌。Objective：To assess the cervical cutting edge status after loop electronic excision procedure（LEEP）,and analyze the result with positive margin.Methods：A retrospective analysis of 350 patients who were diagnosed as cervical intraepithelial neoplasia（CIN）Ⅱ～Ⅲ by colposcopy and had LEEP was performed,to assess the positive results and the prognosis.Results：① 89 patients among 350 patients had positive margins,including 6.90%（6/87） cases of CIN Ⅱ,30.80%（77/250） cases of CIN Ⅲ,and 46.15%（6/13） cases of cervical cancer.② 29 patients had hysterorectomy and one patient had cold knife conization after LEEP,residual diseases were confirmed in 14.29%（2/14） patients with negative margins and 50.00%（8/16） patients with positive margins.③ During the follow up of 242 patients,12 had continuous CIN or progression,including 8 negative margins and 4 positive margins（two progressed into cervical cancer）.Also,in the 12 cases,4 had positive TCT,8 had persistent HPV16 infection.④ In univariate analysis,the positive margin was correlated with the severity of disease（z=4.731,P〈0.001）.Also,positive margin was a high risk factor for residual disease（r=0.378,P=0.039）.Abnormal TCT result after LEEP,high risk HPV subtype and persistent HPV infection were the high risk factors of CIN persistance and progression（P≤0.001）.Multivariate analysis showed the same and persistent HPV subtype infection was the high risk factor for continuous CIN or disease progression（P〈0.001）.Conclusions：The positive cutting margin is related with the severity of disease and residual disease,the same and persistent HPV infection after LEEP should be pay more attention,cause continuous CIN or invasive cervical carcinoma may happen.

关 键 词：宫颈上皮内瘤变 宫颈环形电切术 切缘阳性 人乳头瘤病毒 

分 类 号：R737.33[医药卫生—肿瘤]