重度宫颈上皮内瘤变进行环状电切手术治疗后病灶残余和复发的高危因素

发布时间：2018-05-27 20:54

本文选题：宫颈上皮内瘤变 + 环状电切手术　；参考：《四川大学学报(医学版)》2015年02期

【摘要】：目的探讨预测重度宫颈上皮内瘤变(CIN2及CIN3)进行环状电切手术(LEEP)治疗后残余病灶和疾病复发的高危因素,以及术后及早发现病变的时间点。方法回顾性分析我院进行LEEP治疗的CIN2及CIN3共428例患者资料,治疗后用脱落细胞学和人乳头瘤病毒(HPV)杂交捕获二代(HC2)随访,以阴道镜活检为金标准判定残余和复发,据此评定其余指标的诊断价值。以logistic回归分析危险因素,κ检验验证3月和6月指标的一致性。结果 428例患者中CIN2有296例,CIN3有132例,治疗前HPV HC2阳性率为86.7%(371/428),随访中26例(6.1%)有残余或者复发,LEEP切缘受累特别是锥顶阳性是疾病持续或复发的高危因素〔比值比=9.364,95%可信区间(CI):0.712~46.108,P=0.001〕。其他因素如年龄(截断值40岁)、HPV负荷量(截断值100RLU)、HPV类型(16/18vs.其他类型)均与疾病复发无关。有残余病灶或复发的26例患者术后3月HPV HC2检测均为阳性,HPV HC2在术后3和6个月对于残余病灶的检测敏感性均为100%,均高于细胞学检测(P0.05),而特异性低于细胞学检测(P0.05)。3和6个月的HPV HC2〔κ值为0.70(95%CI,0.469~0.892)〕和细胞学检测结果〔κ值为0.79(95%CI:0.592~0.873)〕都显示出较好的一致性。结论 LEEP手术后切缘受累特别是锥顶阳性是病灶残余或复发的危险因素。术后3月HPV检测可提供关于病灶残余或复发的及时信息。
[Abstract]:Objective to investigate the high risk factors for predicting residual lesions and recurrence of severe cervical intraepithelial neoplasia (CIN2 and CIN3) after cyclic electrosurgical resection (LEEP) and the time point for early detection of the lesions after operation. Methods the data of 428 cases of CIN2 and CIN3 who were treated with LEEP in our hospital were retrospectively analyzed. After treatment, exfoliated cytology and human papillomavirus (HPV) hybridization were used to capture the second generation of HC2). The residual and recurrent cases were determined by colposcopy biopsy as gold standard. The diagnostic value of the other indexes was evaluated accordingly. By logistic regression analysis, 魏 test was used to verify the consistency between March and June. Results there were 296 cases of CIN2 with CIN3 in 132 cases. The positive rate of HPV HC2 before treatment was 86.7% and in follow-up 26 cases were followed up. The residual or recurrent LEEP was involved, especially the positive conical tip was a high risk factor for the disease to persist or recur (the ratio was 9.36495% CI: 0.712495% confidence interval = 0.712495% CI = 0.712495% CI = 0.71246.108P = 0.001). Other factors such as age (truncation value 40 years old) HPV-load (truncated value 100 RLU / HPV type 16 / 18 vs. Other types of disease were not associated with recurrence. In 26 patients with residual lesions or relapses, the sensitivity of HPV HC2 was 100 at 3 and 6 months after operation, which was higher than that of cytological examination (P 0.05), but the specificity was lower than that of cytology. The results of HPV HC2 (魏 = 0.7095) and Cytology (魏 = 0.7995) showed good consistency with those of HPV HC2 (魏 = 0.7995) and HPV HC2 (魏 = 0.7995). Conclusion the involvement of incisal margin, especially the positive conical tip, is a risk factor for residual or recurrent lesions after LEEP operation. 3 months after operation, HPV detection can provide timely information about residual or recurrent lesions.
【作者单位】：四川大学华西第二医院妇产科;
【分类号】：R737.33

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