低级别宫颈上皮内瘤变LEEP锥切术与期待治疗的效果评价

发布时间：2018-05-26 02:20

本文选题：低级别宫颈上皮内瘤变 + 宫颈环形电切术　；参考：《中国妇产科临床杂志》2015年03期

【摘要】：目的回顾宫颈环形电切(loop electrosurgical excision procedure,LEEP)术及药物期待治疗低级别宫颈上皮内瘤变(low grade cervical intraepithelial neoplasia,CIN1)的随访结局;分析病变进展危险因素,探讨CIN1适当的治疗方式。方法收集2007年1月至2012年12月北京妇产医院妇科肿瘤门诊阴道镜指导下宫颈活检病理证实为CIN1患者的临床资料。观察CIN1患者的随访结局。结果收集CIN1患者631例,其中LEEP组286例,药物期待组345例。LEEP组术后病理级别上升18.5%(53/286),其中CIN2 14.7%(42/286),CIN3 3.8%(11/286)。通过中位随访期为36个月的观察,LEEP组(病理未升级者)与药物期待组CIN1持续和进展率分别为8.2%(19/233)、2.6%(6/233)与11.9%(41/345)、2.9%(10/345),两组均未发现浸润癌,差异无统计学意义(P=0.336)。持续高危人乳头瘤病毒(high risk-human papillomavirus,HRHPV)阳性是CIN1持续和进展的独立危险因素,OR值为19.121(95%CI 9.686~37.748,P=0.000)。结论1阴道镜活检证实的CIN1患者选择期待观察是安全的;2 CIN1患者持续HR-HPV阳性超过12个月以上时警惕病变进展,应严密随访。
[Abstract]:Objective to review the follow-up outcome of electrosurgical excision procedure (LEEPP) and drug expectation in the treatment of low grade cervical intraepithelial neoplasia1 (CIN1), to analyze the risk factors of progression and to explore the appropriate treatment of CIN1. Methods from January 2007 to December 2012, clinical data of patients with CIN1 confirmed by cervical biopsy under the guidance of colposcopy in gynecological oncology outpatient department of Beijing Obstetral and Obstetral Hospital were collected. The follow-up outcome of CIN1 patients was observed. Results 631 cases of CIN1 were collected, including 286 cases in LEEP group and 345 cases in drug expectant group. The pathological grade of LEEP group was 18.553 / 286, in which CIN2 14.7% was 42 / 286CIN3 3.8cum. The median follow-up period was 36 months. The CIN1 persistence and progression rates of the two groups were 8.2 / 233 / 2. 6 and 11. 9 / 41 / 345 / 10 / 345, respectively. No invasive carcinoma was found in the two groups. There was no significant difference between the two groups (P < 0. 336). High risk-human papillomavirus positive is an independent risk factor for the persistence and progression of CIN1. The OR value is 19.121(95%CI 9.686 (37.748). Conclusion (1) the CIN1 patients confirmed by colposcopy biopsy should be closely followed up. It is safe to observe that the HR-HPV positive rate of the patients with HR-HPV is safe for more than 12 months.
【作者单位】：首都医科大学附属北京妇产医院妇瘤科;
【基金】：北京市科学技术委员会重大项目(D131100005313009)
【分类号】：R737.33

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