子宫颈癌前病变LEEP术后内切缘阳性行二次LEEP术联合子宫颈管电切术的临床效果  

Clinical effect of secondary LEEP combined with transcervical resection of endocervical tissue for cervical precancerous lesions with positive internal margin after the first LEEP

作　　者：肖晶晶[1] 孙一鑫 汪清[1] 隋龙[1] 张宏伟[1] 丛青[1] Xiao Jingjing;Sun Yixin;Wang Qing;Sui Long;Zhang Hongwei;Cong Qing(Cervical Disease Center,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院宫颈与阴道早期疾病诊疗中心,上海200011

出　　处：《中华妇产科杂志》2024年第10期786-793,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：上海市卫生健康委员会科研项目(202240079)。

摘　　要：目的初步探讨二次子宫颈环形电切(LEEP)术联合宫腔镜下子宫颈管电切术(即二次联合手术)治疗子宫颈高级别鳞状上皮内病变(HSIL)和原位腺癌(AIS)首次LEEP术后内切缘阳性患者的临床效果。方法选择2015年8月—2023年9月复旦大学附属妇产科医院宫颈与阴道早期疾病诊疗中心因子宫颈HSIL、AIS行首次LEEP术后内切缘阳性再行二次联合手术且术后随访1年以上的患者, 对其二次联合手术后的细胞学检查、高危型人乳头状瘤病毒(HR-HPV)检测、阴道镜定期活检结果、子宫颈管长度进行随访, 评估二次联合手术的临床效果。结果 (1)一般临床资料:本研究共纳入患者67例, 其中子宫颈HSIL 34例(HSIL组)、AIS 33例(AIS组)。HSIL组患者首次LEEP术时年龄为(41.3±5.3)岁, 术前HR-HPV检查均阳性, 术前细胞学结果≤低级别鳞状上皮内病变(LSIL)13例、≥HSIL 21例, 术前子宫颈管长度为(3.71±0.17)cm;AIS组患者首次LEEP术时年龄为(39.1±8.7)岁, 术前HR-HPV检测均阳性, 术前细胞学结果≤LSIL 16例、≥HSIL 17例, 术前子宫颈管长度为(3.64±0.21)cm。(2)HSIL组二次联合手术及术后HR-HPV转阴情况:HSIL组患者二次联合手术后子宫颈管HSIL残留率为24%(8/34)。34例HSIL组患者中, 二次联合手术后仍为内切缘阳性者10例(29%, 10/34), 其中5例(5/10)子宫颈管无病灶、5例(5/10)子宫颈管为HSIL;二次联合手术后内切缘阴性者24例(71%, 24/34), 其中3例(12%, 3/24)子宫颈管存在HSIL、21例(88%, 21/24)子宫颈管无病灶。术后6、12个月时随访, 细胞学检查、阴道镜下子宫颈活检均正常;HR-HPV转阴率分别为91%(31/34)和100%(34/34), 其中29例(85%, 29/34)随访时间≥2年患者的HR-HPV均持续阴性(100%, 29/29)。(3)AIS组二次联合手术及术后HR-HPV转阴情况:AIS组患者二次联合手术后子宫颈管中AIS残留(包括进展为浸润性癌)率为15%(5/33)。33例AIS组患者中, 二次联合手术后仍为内切缘阳性�Objective:To preliminarily investigate the clinical outcomes of secondary loop electrosurgical excision procedure(LEEP)combined with transcervical resection of endocervical tissue(i.e.,second combined surgeries)in patients with positive endocervical margins following the initial LEEP for high-grade squamous intraepithelial lesion(HSIL)or adenocarcinoma in situ(AIS)of the cervix.Methods:Patients who underwent second combined surgeries due to positive endocervical margins after the initial LEEP for cervical HSIL or AIS at Obstetrics and Gynecology Hospital,Fudan University between August 2015 and September 2023 were included.Postoperative cytological examinations,high-risk human papillomavirus(HR-HPV)testing,colposcopic biopsy results,and cervical canal length were followed up to evaluate the clinical efficacy of second combined surgeries.Results:(1)General clinical data:a total of 67 patients were enrolled,including 34 with cervical HSIL(HSIL group)and 33 with AIS(AIS group).In the HSIL group before the time of initial LEEP,the mean age was(41.3±5.3)years,with all patients positive for HR-HPV preoperatively.Preoperative cytology results revealed≤low-grade squamous intraepithelial lesion(LSIL)in 13 cases and≥HSIL in 21 cases.The preoperative cervical canal length was(3.71±0.17)cm.Patients in the AIS group before their the first LEEP were at an average age of(39.1±8.7)years old,with preoperative HR-HPV positive.Among them,16 cases showed preoperative cytological results of≤LSIL,while 17 cases showed≥HSIL.The preoperative cervical canal length was(3.64±0.21)cm.(2)Pathological findings and postoperative follow-up of the HSIL group following second combined surgeries:in the HSIL group,the residual rate of HSIL in the endocervical canal tissue(ECT)was 24%(8/34).Out of the 34 HSIL patients,10 cases(29%,10/34)remained with positive endocervical margins post-second combined surgeries.Among these 10 patients,5 cases(5/10)had no lesion detected in ECT,while the remaining 5 cases(5/10)exhibited HSIL in their ECT.C

关 键 词：宫颈肿瘤 宫颈鳞状上皮内病变 腺癌 锥形切除术 宫腔镜检查 电外科手术 乳头状瘤病毒感染 

分 类 号：R737.33[医药卫生—肿瘤]