高危HPV检测及宫颈环形电切术在CIN患者诊治中的应用  

Application of high-risk human papilloma virus testing and loop electrosurgical excision procedure for cervical intraepithelial neoplasia patient

作　　者：冯兰青[1] 刘穗[1] 李琼[1] 魏代奎[2] 陈昌伟[3] 

机构地区：[1]东莞东华医院妇科,广东东莞523110 [2]东莞东华医院分子病理学实验室,广东东莞523110 [3]东莞东华医院病理科,广东东莞523110

出　　处：《分子诊断与治疗杂志》2013年第4期252-256,共5页Journal of Molecular Diagnostics and Therapy

摘　　要：目的探讨高危HPV检测及宫颈环形电切术(LEEP)在诊治宫颈上皮内瘤变(CIN)及早期宫颈癌中的价值。方法回顾性分析183例行高危HPV检测、阴道镜下宫颈多点活组织检查和宫颈环形电切术患者的临床资料,研究高危HPV检测在CIN诊治中的价值,对比阴道镜下宫颈多点活组织病理检查和宫颈环形电切术病理结果的差异,并随访术后2年内复发情况。结果随着CIN级别的升高,高危HPV阳性率升高。高危HPV阳性患者LEEP术后病变复发率10.4%(14/134),高危HPV阴性组无一例复发。阴道镜下宫颈多点活组织病理检查与宫颈环形电切术病理结果完全符合98例(53.6%);术后诊断升级32例(17.5%),复发14例(7.7%);子宫切除治疗24例,升级和复发病例均行相应补充治疗。CIN患者采用宫颈环形电切术、子宫切除治疗2年有效率达92.3%。阴道镜活检浸润癌漏诊率为4.9%(9/183),宫颈环形电切术后切缘阳性率为15.8%(29/183)。结论高危HPV检测对CIN患者LEEP术后复发的预测有很高的灵敏度。阴道镜检查多点活检早期诊断CIN具有较高的准确性。宫颈环形电切术具有手术时间短,出血量少,切净率高的优点,是CIN的主要治疗方法,其对CIN和早期宫颈浸润癌的诊断率高。Objective To study the clinical value of high-risk human papilloma virus （HPV） detection and loop electrosurgical excision procedure （LEEP） in the treatment of cervical intraepithelial neoplasia （CIN） and early cervical cancer. Methods The clinical datas of 183 patients who underwent high-risk HPV testing, vaginoscope multiple biopsies and cervical conization were analysed. The value of high-risk HPV testing had been researched in the diagnosis and treatment of CIN. The results between vaginoscope multiple biopsies and cervical conization was compared. All patients were followed-up for two years. Results In the rising of CIN level and high-risk HPV prevalence, the recurrent rate of patients with high-risk HPV infection taking LEEP was 10.4% （14/134）. The recurrent rate of the patients without high-risk HPV infection taking LEEP was zero. The pathology results of LEEP were completely consistent with the pathology results of vaginoscope multiple biopsy in 98 cases （53.6%）. The pathological level rose up after LEEP in 32 cases （17.5%）, and 14 cases （7.7%） had a recurrence. 24 patients received hysterectomy and all the other cases whose pathological level upgraded or who experienced recurrence received additional treatment. The effective rate of conization treatment and hysterectomy on all C1N patients reached 92.3%. The omission diagnostic rate of colposcopy guided biopsy on invasive carcinoma was 4.9% （9/183）, and the residual rate of the patients taking conization was 15.8% （29/183）. Conclusion High-risk HPV testing had a high sensitivity in predicting the recurrence of CIN patients taking LEEP. Colposcopy including multi-point biopsy had high accuracy in the early diagnosis of C1N. Cervical conization had many advantages such as simple, short operation time, little hemorrhage and high excision rate, which played a very important role in diagnosis of CIN and early cervical cancer.

关 键 词：宫颈上皮内瘤变 阴道镜 宫颈环形电切术 人乳头瘤病毒 

分 类 号：R737.33[医药卫生—肿瘤]