环形电切术治疗高级别宫颈上皮内瘤样病变后人乳头瘤病毒16、18持续感染的影响因素分析

Analysis of influencing factors associated with human papillomavirus 16，18 persistent infection after the treatment for high-grade cervical intraepithelial neoplasia with loop electrosurgical excision procedure

摘要:

目的：探讨宫颈环形电切术（loop electrosurgical excision procedure，LEEP）治疗高级别宫颈上皮内瘤样病变（cervical intraepithelial neoplasia，CIN）术后人乳头瘤病毒（human papillomavirus，HPV）16、18清除的近期效果并分析对HPV16、18持续感染的相关影响因素。方法：选取2007年1月至2009年6月就诊于柳州市人民医院妇科，阴道镜下宫颈活检确诊为CINⅡ/Ⅲ的患者167例。均对其检测HPV16、18 DNA并行宫颈LEEP治疗。术后6个月检测HPV16、18 DNA及液基薄层细胞学检查（thinprep cytologic test，TCT）进行随访。结果：术前感染HPV16、18感染率为77.95%。术后6个月复测HPV16、18感染率为7.87%。术后6个月随访，HPV16、18持续阳性、TCT异常及LEEP后切缘阳性的43例患者行阴道镜下宫颈活检，病变残存率为9.30%。结论：①宫颈LEEP对清除女性生殖道HPV16、18感染有一定作用。②年龄、初次性生活年龄、多产次及切缘阳性是高级别CIN经LEEP治疗后HPV16、18持续感染的影响因素。③切缘阳性是高级别CIN经宫颈LEEP治疗后病变残存的危险因素。

Abstract:

Objective：To discuss the short-term efficacy of loop electrosurgical excision procedure（LEEP） in the treatment of human papillomavirus（HPV）16，18 persistent infection after the operation for high-grade cervical intraepithelial neoplasia（CIN） and to ex－plore the influcing factor of HPV16，18 persistent infection. Methods：Totally 167 cases of CINⅡ/Ⅲ were confirmed by coloposcopy cervical biopsy and received treatment in the department of gynecology of Liuzhou People’s Hospital from January 2007 to June 2009 were enrolled. HPV16，18 DNA was detected in all patients and cervical LEEP was performed on all of them. Thinprep cytologic test（TCT），HPV16，18 DNA detection and follow-up were applied at six months after the operation. Results：HPV infection rate was 77.95l% preoperatively and 7.87% at six months after the operation in the follow-up visit. Cervix biopsy was performed in 43 pa－tients with persistent positive HPV-DNA，abnormal TCT or positive surgical margin. Rate of residual lesions was 9.3%. Conclusions：①HPV16，18 infection in female genital tract can be effectively cleared by LEEP. ②Influencing factors of persistent HPV16，18 in－fection after the treatment of high-grade CIN by LEEP include age，age at first sexual activity，multiple delivery and positive margin involvement. ③Positive margin involvement is the risk factor for the residual lesion of high-grade CIN after treating by LEEP.