子宫颈高级别鳞状上皮内病变LEEP术后病变残留的危险因素分析  

Risk factors of residual lesions in cervical high-grade squamous intraepithelial lesion after LEEP

作　　者：丁竹筠[1] 孙云燕 许丽娟 陈露婷 柴海丽 符丽荣 DING Zhu-yun;SUN Yun-yan;XU Li-juan;CHEN Lu-ting;CHAI Hai-li;FU Li-rong(Department of Obstetrics and Gynecology,Songjiang District Central Hospital,Shanghai 201600,China;不详)

机构地区：[1]上海市松江区中心医院妇产科,上海201600 [2]上海交通大学附属新华医院妇产科 [3]上海交通大学附属国际和平妇幼保健院生殖中心

出　　处：《妇产与遗传（电子版）》2022年第2期30-36,共7页Obstetrics-Gynecology and Genetics (Electronic Edition)

基　　金：上海市松江区医学领先专业建设资助项目(05-Ⅰ-04)。

摘　　要：目的探讨子宫颈高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)行子宫颈环形电极切除术(loop electrosurgical excision procedure,LEEP)术后病变残留的危险因素。方法收集2016年5至2021年5月于上海市松江区中心医院行LEEP术后诊断为子宫颈HSIL,并于3个月内行全子宫切除术的患者共88例,围绝经期患者38例,绝经后患者50例。回顾患者年龄、高危型人乳头瘤病毒(high risk human papillomavirus,HRHPV)分型、子宫颈液基薄层细胞学检查(thinprep cytologic test,TCT)、阴道镜下子宫颈活检P16表达、LEEP术中宫颈管搔刮病检、LEEP术后切缘及全子宫病理检查,统计分析HSIL患者LEEP术后病变残留的危险因素。结果88例患者中,术后无病灶残留64例(73%),有病灶残留24例(27%);围绝经期病灶无残留28例(74%),残留10例(26%);绝经后无残留36例(72%),残留14例(28%),绝经前后病变残留率差异无统计学意义(P>0.05)。所有病例中病灶残留与无残留组,患者年龄、HR-HPV分型、TCT、阴道镜下子宫颈活检P16表达、LEEP术后切缘比较差异无统计学意义(P>0.05),宫颈管搔刮阳性与阴性的差异有统计学意义(P<0.01)。围绝经期病灶残留与无残留组,患者年龄、HR-HPV分型、TCT、阴道镜下子宫颈活检P16表达、LEEP术后切缘差异无统计学意义(P>0.05),宫颈管搔刮阳性与阴性的差异有统计学意义(P<0.01)。绝经后患者病灶残留与无残留组,年龄、高危型人乳头瘤病毒(HPV)分型、子宫颈液基薄层细胞学检查(TCT)、阴道镜下子宫颈活检P16表达、LEEP术中宫颈管搔刮的差异无统计学意义(P>0.05),切缘阳性与阴性的差异有统计学意义(P<0.01)。多因素logistic回归分析显示,宫颈管搔刮阳性为影响LEEP术后病灶残留的危险因素(P<0.01),绝经后切缘阳性为影响LEEP术后病灶残留的危险因素(P<0.05)。结论LEEP术中宫颈管搔刮阳性是HSIL行LEEP术后病灶残留的危险因素。LObjective To investigate the risk factors of residual lesions in cervical high-grade squamous intraepithelial lesion(HSIL)after loop electrosurgical excision procedure(LEEP).Methods A total of 88 patients,including 38 perimenopausal patients and 50 postmenopausal patients,who were diagnosed with cervical HSIL after LEEP in Shanghai Songjiang District Central Hospital from May 2016 to May 2021 and then underwent hysterectomy within 3 months were collected.The patients’age,high risk human papillomavirus(HR-HPV)typing,thinprep cytologic test(TCT),cervical biopsy P16 expression under colposcopy,endocervical curettage(ECC)during LEEP,margin status of LEEP and whole uterine pathology were reviewed and the risk factors of residual lesions after LEEP in HSIL patients were analyzed statistically with t test,χ2test or logistic regression analysis.Results Among the 88 patients,64 cases(73%)had no residual lesions after surgery,and 24 cases(27%)had residual lesions after surgery.Among 38 perimenopausal patients,28 cases(74%)had no residual lesions,and 10 cases(26%)had residual lesions.Among 50 postmenopausal patients,36 cases(72%)had no residual,and 14 cases(28%)had residual.There was no statistical difference in the residual rate between perimenopausal and postmenopausal women(P>0.05).There were no statistically significant differences in age,hr HPV typing,TCT,P16 expression,and LEEP margin between with and without residue group(P>0.05),but there was statistically significant difference in ECC(P<0.01).In perimenopausal group,there were no statistically significant differences in all the factors(P>0.05)except ECC(P<0.01)between with and without residue group.While in postmenopausal group,all the factors were not statistically different(P>0.05)except margin status(P<0.01).Multivariate logistic regression analysis showed that,positive endocervical curettage was a risk factor of the residual lesionsin perimenopausal group after LEEP(P<0.01),and positive LEEP margin was one for postmenopausal patients(P<0.05).Conclusions Posi

关 键 词：高级别鳞状上皮内病变 环形电极切除术 残留 危险因素 

分 类 号：R737.33[医药卫生—肿瘤]