131例HSIL患者LEEP术后病灶残余的危险因素分析及临床转归

发布时间：2018-03-06 04:04

本文选题：HSIL　切入点：LEEP术　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析行宫颈环形电切术(Loop electrosurgical excision procedure,LEEP)后高级别宫颈上皮内瘤变(HSIL)患者病灶残余的相关危险因素及其临床转归情况,评估病灶残余的高危因素,为临床工作提供依据。研究对象和方法:回顾性分析2013年1月-2016年10月就诊于山西医科大学第一医院妇科的初次行LEEP术并行二次全子宫切除的131例HSIL患者的LEEP手术资料、子宫全切住院病历、术后3月、6月、12月门诊随访资料,分析内容包括:一般信息:患者年龄(Age)、绝经状态(Menopausal status)、孕次(Gravidity)、产次(Parity)、术前TCT检测、术前HC2 HPV DNA、HPV(Human papillomavirus)感染亚型、VAIN;LEEP术相关信息:宫颈上皮腺体是否累及、初次LEEP术锥高及锥宽、宫颈病变级别、切缘与病灶的距离;阴道镜检满意否;子宫全切相关信息:出血量、全宫切手术方式、术后标本病理信息等;术后随访TCT检测、HC2 HPV DNA。(1)根据二次全宫切术后病理中是否仍存在HSIL将131例患者分为有病灶残余组和无病灶残余组。对病灶残余可能的相关危险因素进行筛选,继而行回归分析。(2)根据锥切标本切缘与病变距离对切缘阳性进行分组,探讨其与病灶残余的关系;(3)子宫全切术后的高危型HPV的转归。结果:1、进入研究的患者有131例,年龄范围为(33-67)岁,平均(51.22±7.78)岁,手术方式:开腹/腹腔镜构成比例51:80,病灶残余者共52例,残余率为39.70%。2、单因素分析结果提示:病变累及宫颈上皮腺体(OR=2.31,P0.05)、术前HC2HPV DNA负荷量检测300RLU/CO(OR=2.13,P0.05);而与患者年龄、绝经状态、孕产次、术前宫颈薄层液基细胞检测、HPV感染亚型、宫颈病变级别、LEEP锥切的高度和宽度、二次手术与LEEP术平均间隔时间、全宫切平均所用时间、全宫切平均出血量、全宫切手术方式等无关。3、多因素逻辑回归分析(Logistic regression analysis)结果提示:HC2 HPV DNA负荷量为LEEP术后病灶残余的高度危险因子。4、根据锥切标本切缘与病变距离对切缘阳性分为四组(3mm,1-3mm,1mm,切缘可见病变),病灶残余率分别为11.11%(1/9)、11.76%(2/17)、12.90%(8/62)及95.35%(41/43),4组之间的差异有统计学意义(P0.05)。5、子宫全切术后HR HPV的转归:对于术前HR HPV提示高负荷者,全宫切术后定期随访12个月后有124例(94.66%)HR HPV负荷量完全转阴。结论:1、术前HC2 HPV DNA负荷量检测300RLU/CO为LEEP术后病灶残余的高危因素,因此在进行HSIL患者诊治时应对有高危因素的案例应加以注重,以防病灶残余。2、如果在行宫颈锥切术后切缘提示阳性,则切缘距离病变愈近,愈有必要考虑二次手术。3、对LEEP术后切缘阳性且HR HPV高负荷者行全子宫切除术是有意义的。
[Abstract]:Objective: to analyze the risk factors and clinical outcome of the patients with high grade cervical intraepithelial neoplasia (HSILs) after loop electrosurgical excision procedure, and to evaluate the risk factors of residual lesions. Methods: from January 2013 to October 2016, we retrospectively analyzed the LEEP operation data of 131 HSIL patients who underwent LEEP and secondary hysterectomy in gynecology department of the first Hospital of Shanxi Medical University from January 2013 to October 2016. The medical records of total hysterectomy were followed up on March, June and December. The contents of analysis included: age of patients, Menopausal statusus, gravidity of pregnancy, parity of labor, TCT detection before operation. Preoperative HC2 HPV DNA-HPV-Human papillomavirus-related information: involvement of cervical epithelial glands, height and width of initial LEEP cones, grade of cervical lesions, distance between incisal margin and lesion; satisfactory vaginal examination; information related to total hysterectomy: bleeding volume, Methods of total hysterectomy, pathological information of postoperative specimens, etc. TCT was followed up to detect HC2 HPV DNA. 1) according to the presence of HSIL in the pathology after secondary hysterectomy, 131 patients were divided into two groups: the group with or without residual lesions. The possible risk factors of residual lesions were screened. Then regression analysis was carried out. (2) according to the distance between the incised margin and the lesion of the conical specimen, the positive rate of the incisal margin was divided into two groups, and the relationship between the positive margin and the residual lesion was discussed. The outcome of high-risk HPV after total hysterectomy was analyzed. Results: one hundred and thirty-one patients entered the study. The age range was 33-67 years (mean 51.22 卤7.78) years. The operative method: the ratio of laparotomy to laparoscopy was 51: 80. 52 cases had residual lesions. The residual rate was 39.70. 2. The results of univariate analysis showed that the lesion involved the cervix epithelium OR2.31 and the preoperation HC2HPV DNA load was measured by 300RLU / Cochor 2.13 P0.05, but with age, menopausal status, pregnant and parturition, the cervical epithelium was detected for the subtype of HPV-infected by fluid base cells before operation. The height and width of LEEP conical resection, the average interval between secondary surgery and LEEP, the average time of hysterectomy, the mean bleeding amount of total hysterectomy, the degree of cervical lesions, the average time between the second operation and the LEEP procedure, and the mean time taken during the resection of the cervix. The results of multivariate logistic regression analysis showed that the DNA load of HPV / HC2 was a high risk factor of residual lesion after LEEP. According to the incised margin of conical specimen and the distance between the lesion and the cut edge of the specimen, the positive rate of the lesion was divided into four groups. The residual rate of lesion was 11.11 / 9 / 11.76 / 2 / 12.90 / 62) and 95.3535 / 41 / 43 respectively. There was significant difference between the four groups (P < 0.05.5. 5). The outcome of HR HPV after total hysterectomy: it was suggested that HR HPV had high load before and after hysterectomy. After regular follow-up 12 months after hysterectomy, 124 cases of HR HPV load completely turned negative. Conclusion HC2 HPV DNA load of 300RLU / CO is the high risk factor for residual lesions after LEEP operation. Therefore, in the diagnosis and treatment of HSIL patients, we should pay attention to the cases with high risk factors, so as to prevent residual. 2. If positive cutoff after cervical conization, the cutting edge is closer to the lesion. It is necessary to consider the second operation. 3. It is significant for the patients with positive margin after LEEP and high load of HR HPV to perform total hysterectomy.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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