中国临床医生
中國臨床醫生
중국림상의생
JOURNAL OF CHINESE PHYSICIAN
2014年
6期
33-35
,共3页
低度宫颈上皮内瘤变%LEEP锥切术%高危型人乳头瘤病毒
低度宮頸上皮內瘤變%LEEP錐切術%高危型人乳頭瘤病毒
저도궁경상피내류변%LEEP추절술%고위형인유두류병독
Low grade cervical intraepithelial neoplasia%Loop Electrosurgical Excision Procedure%High Risk-hu-man paplliomavirus
目的：探讨LEEP锥切术在低度宫颈上皮内瘤变宫颈上皮轻度非典型增生( CINⅠ)临床诊断和治疗中的价值。方法：对2007年1月至2012年12月期间286例经阴道镜宫颈活检病理证实的CINⅠ患者行LEEP锥切术的完整病例及随访资料进行回顾性分析。结果：①286例CINⅠ患者行LEEP锥切术后病理升级者53例(18.53%),其中CINⅡ者42例(14.68%),CINⅢ者11例(3.85%)。按照LEEP术后病理结果显示的不同CIN级别分组,各组LEEP术前宫颈薄层液基细胞学报告为高度鳞状上皮内病变( HSIL)的例数分别为：炎症0/53例(0),CINI 15/180例(8%),CINII 5/42例(12%),CINⅢ4/11例(36%),P=0.026；同时合并HR-HPV感染的各组例数分别为：炎症30例(57%),CINI 127例(71%),CINII 34例(81%),CINⅢ9例(82%),P=0.049；LEEP术前阴道镜提示多点病灶的各组例数分别为：炎症0例(0),CINI 10例(6%),CINII 5例(12%),CINⅢ8例(80%),P=0.000。②对LEEP术后病理未升级的233例患者进行12~72个月的随访,病变持续存在19例(8.2%),病变进展6例(2.6%),其中CINII 5例,CINⅢ1例。此25例患者中术后持续高危人乳头瘤病毒( HR-HPV)感染15例；>50岁患者中持续和进展病例共10例。③157例LEEP术前HPV阳性患者中107例(68.8%)术后HPV阴转。结论：对细胞学报告为HSIL、合并HR-HPV感染、阴道镜活检病理证实多点CINⅠ患者,建议行LEEP锥切术进一步明确诊断。 LEEP锥切术后HR-HPV持续感染及年龄超过50岁是病变持续及进展的高危因素,需要严密随访。 LEEP锥切术是CINⅠ患者的一种可选择的有效诊治措施。
目的：探討LEEP錐切術在低度宮頸上皮內瘤變宮頸上皮輕度非典型增生( CINⅠ)臨床診斷和治療中的價值。方法：對2007年1月至2012年12月期間286例經陰道鏡宮頸活檢病理證實的CINⅠ患者行LEEP錐切術的完整病例及隨訪資料進行迴顧性分析。結果：①286例CINⅠ患者行LEEP錐切術後病理升級者53例(18.53%),其中CINⅡ者42例(14.68%),CINⅢ者11例(3.85%)。按照LEEP術後病理結果顯示的不同CIN級彆分組,各組LEEP術前宮頸薄層液基細胞學報告為高度鱗狀上皮內病變( HSIL)的例數分彆為：炎癥0/53例(0),CINI 15/180例(8%),CINII 5/42例(12%),CINⅢ4/11例(36%),P=0.026；同時閤併HR-HPV感染的各組例數分彆為：炎癥30例(57%),CINI 127例(71%),CINII 34例(81%),CINⅢ9例(82%),P=0.049；LEEP術前陰道鏡提示多點病竈的各組例數分彆為：炎癥0例(0),CINI 10例(6%),CINII 5例(12%),CINⅢ8例(80%),P=0.000。②對LEEP術後病理未升級的233例患者進行12~72箇月的隨訪,病變持續存在19例(8.2%),病變進展6例(2.6%),其中CINII 5例,CINⅢ1例。此25例患者中術後持續高危人乳頭瘤病毒( HR-HPV)感染15例；>50歲患者中持續和進展病例共10例。③157例LEEP術前HPV暘性患者中107例(68.8%)術後HPV陰轉。結論：對細胞學報告為HSIL、閤併HR-HPV感染、陰道鏡活檢病理證實多點CINⅠ患者,建議行LEEP錐切術進一步明確診斷。 LEEP錐切術後HR-HPV持續感染及年齡超過50歲是病變持續及進展的高危因素,需要嚴密隨訪。 LEEP錐切術是CINⅠ患者的一種可選擇的有效診治措施。
목적：탐토LEEP추절술재저도궁경상피내류변궁경상피경도비전형증생( CINⅠ)림상진단화치료중적개치。방법：대2007년1월지2012년12월기간286례경음도경궁경활검병리증실적CINⅠ환자행LEEP추절술적완정병례급수방자료진행회고성분석。결과：①286례CINⅠ환자행LEEP추절술후병리승급자53례(18.53%),기중CINⅡ자42례(14.68%),CINⅢ자11례(3.85%)。안조LEEP술후병리결과현시적불동CIN급별분조,각조LEEP술전궁경박층액기세포학보고위고도린상상피내병변( HSIL)적례수분별위：염증0/53례(0),CINI 15/180례(8%),CINII 5/42례(12%),CINⅢ4/11례(36%),P=0.026；동시합병HR-HPV감염적각조례수분별위：염증30례(57%),CINI 127례(71%),CINII 34례(81%),CINⅢ9례(82%),P=0.049；LEEP술전음도경제시다점병조적각조례수분별위：염증0례(0),CINI 10례(6%),CINII 5례(12%),CINⅢ8례(80%),P=0.000。②대LEEP술후병리미승급적233례환자진행12~72개월적수방,병변지속존재19례(8.2%),병변진전6례(2.6%),기중CINII 5례,CINⅢ1례。차25례환자중술후지속고위인유두류병독( HR-HPV)감염15례；>50세환자중지속화진전병례공10례。③157례LEEP술전HPV양성환자중107례(68.8%)술후HPV음전。결론：대세포학보고위HSIL、합병HR-HPV감염、음도경활검병리증실다점CINⅠ환자,건의행LEEP추절술진일보명학진단。 LEEP추절술후HR-HPV지속감염급년령초과50세시병변지속급진전적고위인소,수요엄밀수방。 LEEP추절술시CINⅠ환자적일충가선택적유효진치조시。
Objective To evaluate the clinical value of Loop Electrosurgical Excision Procedure ( LEEP) in the diag-nosis and treatment of cervical intraepithelial neoplasia I ( CINI) . Method The clinical data of 286 cases of colpo-scopically directed biopsy with CINI treated with LEEP from 2007 to 2012 were analyzed retrospectively. Result①53(18. 53%) of the women with CINI on directed biopsy had high grade lesions found in loop excursion speci-mens, included CINII 42(14. 68%) and CINⅢ11(3. 85%). ②In the follow-up of the 233 patients who had same or lower grade pathological diagnosis via LEEP among 12 to 72 mouths, it detected that the persistent cases was 19, the progressive cases was 6 which including 5 cases in CINII and 1case in CINⅢ. There were 15 cases having per-sistence infection of HR-HPV after operations in these 25 patients. And in patients who were beyond 50 years old, there were 10 cases having persistent or progression.③There were 107 cases having negative HPV after operations . In 157 patients who had HPV positive per operation. Conclusion We suggest that the LEEP is necessary in further diagnosis to patients who have the HSIL report in cytological test, complicating the infection of HR-HPV and confir-ming CINI by multiple punch biopsies via colposcope. Either the persistent infection of HR-HPV after LEEP or the age beyond 50 years old is the high risk of the persistence and the progression. The patient who has these high risks needs the accurate follow-up. The LEEP is an available, safety and effective measure in both the diagnosis and the treatment of CINI.
