宫颈高级别鳞状上皮内病变锥切术后切缘阳性处理方式的探讨  

Management of the positive resection margin following conization in patients with HSIL high-grade squamous intraepithelial lesion

作　　者：王丽娜 缪懿[2] 卢斌[1] WANG Lina;MIAO Yi;LU Bin(Department of Gynecology,Wuxi Maternal and Child Health Hospital,Wuxi 214000,China)

机构地区：[1]无锡市妇幼保健院妇科,江苏无锡214000 [2]上海市第一人民医院妇科,上海200080

出　　处：《皖南医学院学报》2021年第2期139-142,共4页Journal of Wannan Medical College

基　　金：国家自然科学基金项目(81702553)。

摘　　要：目的:通过对宫颈高级别鳞状上皮内病变(HSIL)行锥切术后内切缘阳性及外切缘阳性不同处理方式的探讨,总结治疗经验。方法:选择2016年12月~2019年12月在无锡市妇幼保健院宫颈科行宫颈环形电切(LEEP)术的患者共1526例,其中切缘阳性187例(内切缘阳性82例,外切缘阳性105例)。内切缘阳性术后补充手术治疗,外切缘阳性术后4~6个月随访宫颈液基薄层细胞学检测(TCT)、高危型HPV(HR-HPV)检测、阴道镜下宫颈活检。分析内切缘及外切缘阳性患者的病例特征,探讨术后病灶残留率,分析TCT及HR-HPV检测在外切缘阳性术后随访中的应用价值。结果:①内切缘阳性组的年龄[(49.63±10.77)岁]高于外切缘阳性组[(39.28±8.46)岁](P<0.05)。内切缘阳性组的绝经状态、多重HR-HPV感染、阴道镜检不满意及腺体累及的患者多于外切缘阳性组(P<0.05),两组的主诉症状、锥切深度及宽度差异无统计学意义(P>0.05)。②内切缘阳性组25.61%(21/82)的患者补充手术术后无病灶残留,65.85%(54/82)患者证实有病灶残留,8.54%(7/82)术后病理升级为宫颈早期浸润癌。③外切缘阳性组的阴道镜活检病理结果显示,91.43%(96/105)的外切缘阳性患者无残留病灶,8.57%(9/105)的患者存在残留。术后随访TCT对病灶残留的诊断灵敏度为88.89%(8/9),特异度为90.63%(87/96),术后随访HR-HPV E6&E7 mRNA对病灶残留的诊断灵敏度为100%(9/9),诊断特异度为54.17%(52/96)。结论:内切缘阳性患者的病灶残留率高,且有病变升级的风险,术后行补充手术是必要的,外切缘阳性组的病灶残留率低,术后可4~6个月随访TCT及HR-HPV,其中之一有异常时则行阴道镜下活检。Objective:To investigate different treatment strategies for,and summarize the clinical experience in managing positive internal and external resection margin of cervical cancer following conization in patients with high-grade squamous intraepithelial lesion(HSIL).Methods:Totally,1526 patients(positive internal resection margin:n=82;positive external resection margin:n=105)undergone cervical loop electrosurgical excision procedure(LEEP)in the Gynecology Department of Wuxi Maternal and Child Health Hospital were included from December 2016 to December 2019.Patients with positive internal resection margin were further surgically treated,and those with positive external resection margin received Thinprep liquid-based cytology test(TCT),high risk human papilliomavirus(HR-HPV)test and colposcopy cervical biopsies in 4-6 months of follow-up.The characteristics of positive internal and external resection margin and residual rate of the resection were analyzed.Also,the value of TCT and HR-HPV tests in follow-up was evaluated for patients with positive external resection margin of cervical cancer.Results:①The age of patients in positive internal resection margin group was significantly older than that of those in positive external resection margin group[(49.63±10.77)years vs.(39.28±8.46)years,P<0.05].The case number of menopausal status,multiple HR-HPV infection,unsatisfactory colposcopy and gland involvement was greater in the positive internal resection margin group than in positive external resection margin group(P<0.05),yet two groups were not significantly different in chief complaint symptoms,depth and width of LEEP(P>0.05);②In the positive internal resection margin group,residual disease was free in 25.61%(21/82)of the patients following added surgery,yet occurred in 65.85%(54/82),and 8.54%of the patients were progressed to early cervical invasive carcinoma by pathology confirmation;③The pathological examination of the biopsies for the positive external resection group showed that 91.43%of the patients had n

关 键 词：宫颈高级别鳞状上皮内病变 宫颈锥切术 内切缘阳性 外切缘阳性 病灶残留 

分 类 号：R713.4[医药卫生—妇产科学] R737.33[医药卫生—临床医学]