1005例子宫颈HSIL患者行LEEP术后24个月内的复发及其影响因素分析  

Analysis of recurrence and its influencing factors in patients with cervical HSIL within 24 months after LEEP

作　　者：陈丽梅[1] 刘莉[2] 陶祥 何媛[4] 郭罗培 张宏伟[1] 周先荣 隋龙[1] Chen Limei;Liu Li;Tao Xiang;He Yuan;Guo Luopei;Zhang Hongwei;Zhou Xianrong;Sui Long(Center for Diagnosis and Treatment of Cervical Diseases, Obstetrics and Gynecology Affiliated to Fudan University, Key Laboratory of Female Reproductive Endocrine Related Diseases in Shanghai, Shanghai 200011, China;Health Management Center, Huashan Hospital Affiliated to Fudan University, Shanghai 200031, China;Department of Pathology, Obstetrics and Gynecology Affiliated to Fudan University, Shanghai 200011, China;Department of Organization, Obstetrics and Gynecology Hospital Affiliated to Fudan University, Shanghai 200011, China)

机构地区：[1]复旦大学附属妇产科医院宫颈疾病诊治中心暨上海市女性生殖内分泌相关疾病重点实验室,200011 [2]复旦大学附属华山医院健康管理中心,上海200031 [3]复旦大学附属妇产科医院病理科,上海200011 [4]复旦大学附属妇产科医院组织部,上海200011

出　　处：《中华妇产科杂志》2019年第8期534-540,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金(81701398);上海市科学技术委员会科研计划(16411950200).

摘　　要：目的探讨子宫颈高级别鳞状上皮内病变(HSIL)患者行子宫颈环形电极切除(LEEP)术后24个月的复发情况,并对影响复发的因素进行分析。方法收集2011年1月—2013年12月在复旦大学附属妇产科医院行LEEP术且术后诊断为HSIL、术后6个月内随访阴道镜检查为无残留且有术后24个月随访资料的患者共1 005例,LEEP术后随访内容包括细胞学检查、高危型HPV(HR-HPV)检测、阴道镜下子宫颈活检,随访时间为术后4~6、12、24个月。(1)分析HSIL患者LEEP术后的复发情况;(2)比较复发与未复发患者之间的年龄及LEEP术锥切标本参数(包括长度、宽度和周长)的差异;(3)比较HSIL患者LEEP术后不同切缘状态的复发率;(4)探讨不同随访方法对复发的预测价值;(5)分析影响复发的危险因素。结果(1)1 005例HSIL行LEEP术的患者中,术后12个月随访发现复发5例、进展为微小浸润癌1例、LSIL 17例,继续随访至术后24个月又发现复发8例、LSIL 11例、进展为原位腺癌1例和子宫颈癌Ⅰb1期1例。LEEP术后24个月的累计复发患者13例,复发率为1.3%(13/1005);累计进展患者3例,进展率为0.3%(3/1005)。(2)复发患者的年龄以及LEEP术锥切标本的长度、宽度和周长分别与未复发患者比较,差异均无统计学意义(P>0.05)。(3)内切缘阳性患者的复发率为3/16,与纤维间质切缘阳性者(6.5%,2/31)比较无显著差异(P=0.320);外切缘阳性患者的复发率为2.8%(2/72),与切缘阴性者(0.7%,6/882)比较也无显著差异(P=0.117);内切缘阳性患者的复发率分别与切缘阴性者和外切缘阳性者相比均显著升高(P<0.01,P=0.040)。(4)术后细胞学检查联合HR-HPV检测预测HSIL复发的敏感度和阴性预测值均为100.0%。(5)logistics回归模型多因素分析显示,LEEP术后内切缘阳性、术后随访细胞学检查异常、术后随访HR-HPV阳性均为影响HSIL患者LEEP术后复发的独立因素(P<0.05)。结论LEEP术后24个月的复发率为1.3%,年龄Objective To analyze clinical outcome of high grade squamous intraepithelial lesion (HSIL) within 24 months after loop electrosurgical excision procedure (LEEP), and to explore risk factors of recurrent cervical HSIL, the risk of progress into cervical cancer and methods of follow-up. Methods This retrospective study was carried out on 1 005 patients who underwent LEEP, diagnosing with HSIL after LEEP from January 2011 to December 2013 at Obstetrics and Gynecology Hospital Affiliated to Fudan University to confer the difference between non-recurrent group and recurrent group 24 months after the LEEP conization. Patients were followed with ThinPrep cytologic test (TCT), high risk HPV (HR-HPV) test, colposcopy guided biopsy. Results A total of 1 005 cases were enrolled in this study with HSIL in the LEEP specimen, no residual HSIL in the 6-month follow up, and have follow up records in 24 months after LEEP. HSIL recurred in 5 cases, microinvasive carcinoma in 1 case, low grade squamous intraepithelial lesion (LSIL) in 17 cases at 12 months follow-up. HSIL recurred in 8 cases, LSIL in 11 cases, adenocarcinoma in situ in 1 case, and invasive cervical carcinoma in 1 case in Ⅰb1 stage at 24 months after LEEP. The recurrence rate was 1.3%(13/1 005), and the progression rate was 0.3%(3/1 005). There was no significant difference in age, length, circumference and width of LEEP between recurrent and non-recurrent patients (P>0.05). The recurrence rate was highest in the endocervical positive margin group with 3/16, which was higher than ectocervical positive margin and negative margin (P<0.01, P=0.040, respectively). The recurrence rate of endocervical positive margin group and fibrous interstitial positive margin group showed no significant difference (P=0.320). There was no significant difference between ectocervical positive margin and negative margin [2.8%(2/72) vs 0.7%(6/882), P=0.117]. Postoperative cytological examination combined with HR-HPV detection has a high sensitive and high negative predictor value of HSIL

关 键 词：宫颈鳞状上皮内病变 电外科手术 妇科外科手术 肿瘤复发 局部 阴道涂片 乳头状瘤病毒科 危险因素 

分 类 号：R737.33[医药卫生—肿瘤]