摘要
目的：探讨LEEP锥切术在低度宫颈上皮内瘤变宫颈上皮轻度非典型增生（ CINⅠ）临床诊断和治疗中的价值。方法：对2007年1月至2012年12月期间286例经阴道镜宫颈活检病理证实的CINⅠ患者行LEEP锥切术的完整病例及随访资料进行回顾性分析。结果：①286例CINⅠ患者行LEEP锥切术后病理升级者53例（18.53%）,其中CINⅡ者42例（14.68%）,CINⅢ者11例（3.85%）。按照LEEP术后病理结果显示的不同CIN级别分组,各组LEEP术前宫颈薄层液基细胞学报告为高度鳞状上皮内病变（ HSIL）的例数分别为：炎症0/53例（0）,CINI 15/180例（8%）,CINII 5/42例（12%）,CINⅢ4/11例（36%）,P=0.026；同时合并HR-HPV感染的各组例数分别为：炎症30例（57%）,CINI 127例（71%）,CINII 34例（81%）,CINⅢ9例（82%）,P=0.049；LEEP术前阴道镜提示多点病灶的各组例数分别为：炎症0例（0）,CINI 10例（6%）,CINII 5例（12%）,CINⅢ8例（80%）,P=0.000。②对LEEP术后病理未升级的233例患者进行12-72个月的随访,病变持续存在19例（8.2%）,病变进展6例（2.6%）,其中CINII 5例,CINⅢ1例。此25例患者中术后持续高危人乳头瘤病毒（ HR-HPV）感染15例；＆gt;50岁患者中持续和进展病例共10例。③157例LEEP术前HPV阳性患者中107例（68.8%）术后HPV阴转。结论：对细胞学报告为HSIL、合并HR-HPV感染、阴道镜活检病理证实多点CINⅠ患者,建议行LEEP锥切术进一步明确诊断。 LEEP锥切术后HR-HPV持续感染及年龄超过50岁是病变持续及进展的高危因素,需要严密随访。 LEEP锥切术是CINⅠ患者的一种可选择的有效诊治措施。
Objective To evaluate the clinical value of Loop Electrosurgical Excision Procedure （ LEEP） in the diag-nosis and treatment of cervical intraepithelial neoplasia I （ CINI） . Method The clinical data of 286 cases of colpo-scopically directed biopsy with CINI treated with LEEP from 2007 to 2012 were analyzed retrospectively. Result①53（18. 53%） of the women with CINI on directed biopsy had high grade lesions found in loop excursion speci-mens, included CINII 42（14. 68%） and CINⅢ11（3. 85%）. ②In the follow-up of the 233 patients who had same or lower grade pathological diagnosis via LEEP among 12 to 72 mouths, it detected that the persistent cases was 19, the progressive cases was 6 which including 5 cases in CINII and 1case in CINⅢ. There were 15 cases having per-sistence infection of HR-HPV after operations in these 25 patients. And in patients who were beyond 50 years old, there were 10 cases having persistent or progression.③There were 107 cases having negative HPV after operations . In 157 patients who had HPV positive per operation. Conclusion We suggest that the LEEP is necessary in further diagnosis to patients who have the HSIL report in cytological test, complicating the infection of HR-HPV and confir-ming CINI by multiple punch biopsies via colposcope. Either the persistent infection of HR-HPV after LEEP or the age beyond 50 years old is the high risk of the persistence and the progression. The patient who has these high risks needs the accurate follow-up. The LEEP is an available, safety and effective measure in both the diagnosis and the treatment of CINI.
出处
《中国临床医生杂志》
2014年第6期33-35,共3页
Chinese Journal For Clinicians
关键词
低度宫颈上皮内瘤变
LEEP锥切术
高危型人乳头瘤病毒
Low grade cervical intraepithelial neoplasia
Loop Electrosurgical Excision Procedure
High Risk-hu-man paplliomavirus
