激光和光动力治疗及随访观察在子宫颈低级别鳞状上皮内病变管理中的意义一项前瞻性队列研究  

Value of laser therapy,photodynamic therapy,and follow-up observation in the management of cervical low-grade squamous intraepithelial lesions:a prospective cohort study

作　　者：张璐[1] 孟凡婷 吴江南[3] 隋龙[1] 丛青[1] Zhang Lu;Meng Fanting;Wu Jiangnan;Sui Long;Cong Qing(Cervical Disease Center,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China;Department of Gynecology,The People′s Hospital of Suzhou New District,Suzhou 215129,China;Department of Epidemiology,Obstetrics and Gynecology Hospital of 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 [2]苏州高新区人民医院妇科,苏州215129 [3]复旦大学附属妇产科医院流行病学教研室,上海200011

出　　处：《中华妇产科杂志》2024年第11期848-855,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);上海市科学技术委员会科技创新行动计划(22MC1940200)。

摘　　要：目的探讨CO_(2)激光治疗、光动力治疗和随访观察3种方法在子宫颈低级别鳞状上皮内病变(LSIL)管理中的意义。方法收集2021年1月1日至2023年12月31日于复旦大学附属妇产科医院经阴道镜下活检病理诊断为子宫颈LSIL且合并高危型人乳头状瘤病毒(HR-HPV)感染的患者。由患者自愿选择治疗方式,根据1∶1配比,共纳入激光组、光动力组和随访组各107例。比较3组患者治疗后6~12个月随访时的病灶缓解率及HR-HPV转阴率。结果(1)治疗前3组患者一般临床病理资料的比较:321例子宫颈LSIL患者的年龄为(34.9±8.1)岁,治疗前51.7%(166/321)的患者存在细胞学异常,35.2%(113/321)的患者HPV 16和(或)18型(HPV 16/18型)阳性,阴道镜诊断的准确率为69.2%(222/321)。激光组、光动力组、随访组患者的年龄、细胞学结果、HPV 16/18型阳性率、阴道镜诊断结果分别比较,差异均无统计学意义(P均>0.05)。(2)治疗后3组患者病灶缓解率和HR-HPV转阴率的比较:治疗后6~12个月随访时,激光组的病灶缓解率高达89.7%(96/107),略高于光动力组的86.9%(93/107),两组比较,差异无统计学意义(χ^(2)=0.41,P=0.523);但两组均显著高于随访组(64.5%,69/107;χ^(2)=19.30,P<0.001;χ^(2)=14.63,P<0.001)。激光组和光动力组的HR-HPV转阴率分别为73.8%(79/107)和68.2%(73/107),均显著高于随访组(32.7%,35/107;χ^(2)=36.34,P<0.001;χ^(2)=26.99,P<0.001);但激光组与光动力组间比较,差异则无统计学意义(χ^(2)=0.82,P=0.366)。结论CO_(2)激光和光动力是子宫颈LSIL有效的治疗方法,在病灶缓解率和HR-HPV转阴率方面均显著优于随访观察。在有病灶进展的高风险患者中,可根据患者的年龄、HR-HPV感染情况、阴道镜检查结果及经济条件制定个体化的方案。Objective To explore the value of CO_(2)laser therapy,photodynamic therapy,and follow-up observation in the management of cervical low-grade squamous intraepithelial lesion(LSIL).Methods Women diagnosed with cervical LSIL and high risk human papillomavirus(HR-HPV)infection through colposcopy-guided biopsy from January 1,2021 to December 31,2023 were collected.According to a 1∶1 ratio,107 cases were included in each of the laser treatment,photodynamic therapy,and follow-up groups.The complete remission rate and HR-HPV clearance rate were compared during the 6-12 months follow-up period.Results(1)Comparison of clinical data among the three groups before treatment:the median age of the 321 patients was(34.9±8.1)years.Before treatment,cytological abnormalities were present in 51.7%(166/321)of patients,and 35.2%(113/321)had human papillomavirus(HPV)16/18 infections.The accuracy rate of colposcopic diagnosis was 69.2%(222/321).Age,cytology results,HPV 16/18 infection,and colposcopy diagnosis in the laser group,photodynamic group,and follow-up group were compared,and there were not statistically significant differences(all P>0.05).(2)During the 6-12 months follow-up period,the complete remission rate was 89.7%(96/107)in the laser group,slightly higher than the 86.9%(93/107)in the photodynamic group,with no statistical difference between the two groups(χ^(2)=0.41,P=0.523).However,both were significantly higher than the 64.5%(69/107)in the follow-up group(χ^(2)=19.30,P<0.001;χ^(2)=14.63,P<0.001).The HR-HPV clearance rates in the laser and photodynamic groups were 73.8%(79/107)and 68.2%(73/107),respectively,both significantly higher than the 32.7%(35/107)in the follow-up group(χ^(2)=36.34,P<0.001;χ^(2)=26.99,P<0.001),but with no statistical difference between the laser and photodynamic groups(χ^(2)=0.82,P=0.366).Conclusions CO_(2)laser therapy and photodynamic therapy are effective treatments for cervical LSIL,significantly superior to follow-up observation in terms of lesion remission and HR-HPV clearance rates.I

关 键 词：宫颈鳞状上皮内病变 乳头状瘤病毒感染 激光疗法 光化学疗法 随访研究 队列研究 

分 类 号：R737.33[医药卫生—肿瘤]