人乳头状瘤病毒检测对宫颈上皮内瘤样病变Ⅱ~ⅢLEEP术后切缘阳性的预后评估

Prognosis assessment on cervical intraepithelial neoplasia Ⅱ-Ⅲ with positive margins after LEEP by human papillomavirus genotyping

摘要:

目的：对宫颈上皮内瘤样病变（Cervical intraepithelial neoplasia，CIN）Ⅱ～Ⅲ行超频电刀环切术（Loop electrosurgical excision procedure，LEEP）术后切缘阳性患者定期随访，通过人乳头状瘤病毒（Human papillomavirus，HPV)分型检测进行预后评估，从而指导临床合理治疗；方法：回顾性分析702例CINⅡ～Ⅲ中行LEEP术后切缘阳性的患者65例（9.26%），检测其术前、术后6、12、18月及24月HPV分型、薄层液基细胞学涂片（ThinPrep cell test，TCT）及阴道镜情况；结果：切缘阳性患者复发率高于切缘阴性患者（P<0.05）；术前各HPV亚型、多重HPV感染以及切缘残留病灶级别与患者的复发率无相关性（P＞0.05）；但术后6月HPV持续感染与高复发率有密切相关性（P<0.05）；讨论：CINⅡ～Ⅲ LEEP术后切缘阳性患者定期行HPV分型，可有助于检测病灶复发。

Abstract:

Objective：To assess the prognosis after loop electrosurgical excision procedure（LEEP） of cervical intraepithelial neopla－siaⅡ-Ⅲ（CINⅡ-Ⅲ） with positive margins by human papillomavirus（HPV） genotyping in order to guide clinical treatment. Meth－ods：Totally 65 cases （9.26%） were found positive margins in 702 cases of CINⅡ-Ⅲ after LEEP. ThinPrep cell test（TCT），colpo－scope and HPV genotype were performed preoperatively and at every 6 months after LEEP. Results：The recurrence rate of positive margins was higher than that of negative margins（P<0.05）. The recurrence was not correlated with HPV subtype，multiple HPV types and lesions grade in incision margins（P ＞0.05）. But the persistence HPV infection was associated with higher recurrence rates at 6 months after the operation（P<0.05）. Conclusion：HPV genotype may help to detect recurrences in CINⅡ-Ⅲ with positive margins after LEEP.