经阴道分离膀胱直肠间隙的宫颈LEEP术后HPV转阴情况及生育能力分析  

Analysis of fertility preservation and HPV negative conversion rate of LEEP by separating the vesicorectal space

作　　者：姜婷 谢俣 龚滢欣 张运强 石月 郭若怡 汪清 刘晓霞 JIANG Ting;XIE Yu;GONG Ying-xin;ZHANG Yun-qiang;SHI Yue;GUO Ruo-yi;WANG Qing;LIU Xiao-xia(Department of Gynaecology,Obstetrics and Gynaecology Hospital,Fudan University,Shanghai 200011,China;Center of Diagnosis and Treatment for Cervical Diseases,Obstetrics and Gynaecology Hospital,Fudan University,Shanghai 200011,China;Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,Shanghai 200011,China;Department of Gynaecology,Obstetrics and Gynaecology Hospital,Fudan University,Yangtze River Delta Integration Demonstration Zone(Qingpu),Shanghai 201713,China)

机构地区：[1]复旦大学附属妇产科医院妇科,上海200011 [2]复旦大学附属妇产科医院妇科宫颈疾病诊治中心,上海200011 [3]上海市女性生殖内分泌相关疾病重点实验室,上海200011 [4]复旦大学附属妇产科医院长三角一体化示范区青浦分院妇科,上海201713

出　　处：《复旦学报（医学版）》2024年第2期211-217,共7页Fudan University Journal of Medical Sciences

基　　金：上海市卫健委卫生行业临床研究专项青年项目(20214Y0021)。

摘　　要：目的探讨子宫颈高级别鳞状上皮内病变(high-grade cervical intraepithelial neoplasia,HSIL)患者行经阴道分离膀胱直肠间隙的宫颈环形电切术(loop electrosurgical excision procedure,LEEP)后人乳头状瘤病毒(human papillomavirus,HPV)转阴情况及生育力。方法收集2019年1—12月在复旦大学附属妇产科医院行经阴道分离膀胱直肠间隙的宫颈LEEP术患者53例,术后行子宫颈脱落细胞学检查、HPV检测和阴道镜下子宫颈活检,随访时间分别为6、12和24个月。分析患者术前HPV感染分布及保育成功率,经阴道分离膀胱直肠间隙的宫颈LEEP术后HPV转阴情况,术后切缘阳性和病理类型分布,HPV感染类型对术后切缘阳性的影响及患者术后生育情况。结果53例患者中,94.3%(50/53)存在HPV感染,其中75.5%(40/53)为HPV16/18型感染者,69.8%(37/53)为HPV单一亚型感染,高于混合感染22.7%(12/53);71.7%(38/53)前次LEEP术后切缘阳性,28.3%(15/53)HSIL复发;56.6%(30/53)术后病理HSIL,28.3%(15/53)未发现病理性改变;75.5%(40/53)术后切缘阴性(即保育成功),其中95%(38/40)HPV转阴。比较HPV16/18感染(P=0.196)和HPV感染类型(P=1.000)对术后切缘阳性的影响,差异无统计学意义。5例保育成功的患者在术后完成生育(12.5%,5/40),其中顺产1例,剖宫产4例。5例均为足月分娩,3例行宫颈环扎术,2例患者未行宫颈环扎。结论子宫颈HSIL患者行经阴道分离膀胱直肠间隙的宫颈LEEP术后保育成功率高,术后HPV转阴率高。Objective To explore the eradication rate of human papillomavirus(HPV)and gestational outcome of patients with high-grade squamous intraepithelial disease of the cervix(HSIL)after loop electrosurgical excision procedure(LEEP)by transvaginal dissection of the vesicorectal form the cervix.Methods A total of 53 patients treated with LEEP by transvaginal dissection of the vesicorectal form the cervix in Obstetrics and Gynecology Hospital,Fudan University from Jan to Dec,2019 were investigated.Clinical information of cervical cytological examination,HPV test and cervical biopsy under colposcopy were followed up for 6,12 and 24 months post-LEEP were collected.HPV infection in these 53 patients were compared before and after LEEP surgery.The rate of successful fertility of the cohort,the HPV conversion rate of patients with hysterectomy and LEEP done were compared.The association between the pathological type and positive surgical margin and the association between HPV infection type and positive surgical margin were analyzed.Results HPV infection rate of was 94.3%(50/53)and the proportion of HPV16 and/or 18 infection was 75.5%(40/53).Mono-HPV infection rate(69.8%,37/53)was significantly higher than mixed HPV infection rate(22.7%,13/53).Thirty-eight patients(71.7%)were found with positive surgical margin in previous LEEP operation.Fifteen patients had recurrence(28.3%)and 40 patients(75.5%)successfully delivered baby after surgery.Postoperative pathology was mainly HSIL,accounting for 66%(30/53),and 28.3%patients(15/53)had no pathological change.Forty cases had satisfying fertility-conservative operation outcome with negative surgical margin,and 38 patients eradicated HPV infection after LEEP,which took up 95%of patients with satisfying fertilityconservative operation.There was no significant difference of positive resection margin rate in between groups of HPV16/18 infection and other types.Five cases had successful delivery(12.5%,5/40)with 1 case of vaginal delivery and 4 cases of cesarean section.Among these 5 cases,

关 键 词：人乳头状瘤病毒(HPV) 生育力保存 高级别鳞状上皮内病变(HSIL) 宫颈环形电切术(LEEP) 

分 类 号：R713.44[医药卫生—妇产科学]