CAJ | 학술논문

目的：探讨人乳头瘤病毒（ HPV）分型检测联合阴道镜检查在监测高级别宫颈上皮内瘤变（ CINⅡ／Ⅲ）锥切术后病变残留或复发中的临床价值及应用。方法选取行宫颈锥切术治疗的CINⅡ／Ⅲ患者159例（其中CINⅡ级53例，CINⅢ106例），分别于术后3个月、6个月、12个月、18个月、24个月进行随访。每次随访均行HPV分型检测、宫颈细胞学检查，对HPV阳性或细胞学异常的患者行阴道镜检查并取活检，比较不同时间间隔病变的残留或复发率。结果术后3个月与6个月比较，差异无统计学意义，与12个月比较，差异具有统计学意义；术后12个月与18个月比较，差异无统计学意义，与24个月比较，差异有统计学意义；HPV分型检测联合阴道镜检查的敏感性为95．00％，特异性为98．97％，与TCT＋HPV＋阴道镜检查相比较，差异无统计学意义。结论术后2年内的随访时间间隔可为术后3个月、12个月、24个月；HPV分型检测可作为CINⅡ／Ⅲ锥切术后的随访监测的重要指标，HPV分型检测联合阴道镜检查能够增加其预测宫颈病变残留或复发的敏感性和特异性。
목적：탐토인유두류병독（ HPV）분형검측연합음도경검사재감측고급별궁경상피내류변（ CINⅡ／Ⅲ）추절술후병변잔류혹복발중적림상개치급응용。방법선취행궁경추절술치료적CINⅡ／Ⅲ환자159례（기중CINⅡ급53례，CINⅢ106례），분별우술후3개월、6개월、12개월、18개월、24개월진행수방。매차수방균행HPV분형검측、궁경세포학검사，대HPV양성혹세포학이상적환자행음도경검사병취활검，비교불동시간간격병변적잔류혹복발솔。결과술후3개월여6개월비교，차이무통계학의의，여12개월비교，차이구유통계학의의；술후12개월여18개월비교，차이무통계학의의，여24개월비교，차이유통계학의의；HPV분형검측연합음도경검사적민감성위95．00％，특이성위98．97％，여TCT＋HPV＋음도경검사상비교，차이무통계학의의。결론술후2년내적수방시간간격가위술후3개월、12개월、24개월；HPV분형검측가작위CINⅡ／Ⅲ추절술후적수방감측적중요지표，HPV분형검측연합음도경검사능구증가기예측궁경병변잔류혹복발적민감성화특이성。
[ ABSTRACT] Objective To explore the clinical value and application of human papillomavirus ( HPV) genoty-ping combined with colposcopy in monitoring the residual or recurrent disease in the follow-up of CINⅡ/Ⅲafter coniza-tion.Methods One hundred ang fifty-five cases after the treatment of the cervical cone cutting of CINⅡ/Ⅲ patients (including 53 cases of CINⅡ,106 cases of CINⅢ) were selected and the followed up after 3 months,6 months,12 months,18 months,24 months were made respectively .HPV genotyping and cervical cytology were necessary for every visit.Colposcopy and biopsy were necessary when HPV positive or cytological abnormalities .A comparative analysis was made among the monitoring results in different time intervals ,andthe clinic value of HPV typing detection combined with colposcopy in the prediction of residual or recurrence of disease after the treatment of the cervical cone cutting of CIN Ⅱ/Ⅲwere analyzed .Results There was no statistically significant difference between the third month and the sixth month , but statistically significant difference was existed between the third month and the twelfth month .There was no statistical-ly significant difference between the twelfth month and the eighteenth month , but statistically significant difference was existed between the twelfth month and the eighteenth month .The sensitivity of HPV genotyping combined with colposco-py,was 95.00%and its specificity was 98.97%.There was no statistically significant difference when put to compare with the method of TCT+HPV+Colposcopy .Conclusion In the first 2 years after surgery ,it can follow-up at the third month ,the twelfth month and the twenty-forth month;HPV genotyping was considered to be the important indicator of mo-nitoring the residual or recurrent disease in the follow-up of CINⅡ/Ⅲafter conization ,and its sensitivity and specificity of predicting residual or recurrence of cervical lesions increased after combining it with colposcopy .