CAJ | 학술논문

目的探讨宫颈液基细胞学检查(LCT)和高危型人乳头瘤病毒DNA检查,对宫颈高度鳞状上皮内病变子宫颈环形电切除术(LEEP)后切缘累及患者随访中的价值.方法回顾性分析2004年6月至2013年4月在上海交通大学医学院附属国际和平妇幼保健院官颈疾病诊治中心行LEEP手术,并且病理学诊断为宫颈高度鳞状上皮内病变(HSIL)切缘有病灶累及的404例患者,术后12个月内LCT、高危型人乳头瘤病毒(HR-HPV) DNA的随访结果;根据2次手术的病理学诊断,对LCT和HR-HPV DNA检查结果对病灶是否残留或复发进行预测分析.结果 HSIL且LEEP术后切缘累及的患者,术后1年有18.7％可出现宫颈细胞学检查再次异常和(或)HPV再次感染或复发,有51.1％的患者宫颈细胞学检查可持续异常和(或)HPV持续感染.LCT联合HR-HPV DNA检查对病灶是否残留或复发的阳性预测值为60.0％,阴性预测值100％,灵敏度100％,特异度52.9％,阳性似然比为2.1,阴性似然比为0.5,比数比为4.5.结论对于HSIL且LEEP术后切缘累及的患者,术后复查LCT和(或)HR-HPV DNA可成为两项联合检验监测方法.对结果有异常和阳性的病例,可再次阴道镜检查重新评估官颈病变程度,为2次手术提供依据.
목적 탐토궁경액기세포학검사(LCT)화고위형인유두류병독DNA검사,대궁경고도린상상피내병변자궁경배형전절제술(LEEP)후절연루급환자수방중적개치.방법 회고성분석2004년6월지2013년4월재상해교통대학의학원부속국제화평부유보건원관경질병진치중심행LEEP수술,병차병이학진단위궁경고도린상상피내병변(HSIL)절연유병조루급적404례환자,술후12개월내LCT、고위형인유두류병독(HR-HPV) DNA적수방결과;근거2차수술적병이학진단,대LCT화HR-HPV DNA검사결과대병조시부잔류혹복발진행예측분석.결과 HSIL차LEEP술후절연루급적환자,술후1년유18.7％가출현궁경세포학검사재차이상화(혹)HPV재차감염혹복발,유51.1％적환자궁경세포학검사가지속이상화(혹)HPV지속감염.LCT연합HR-HPV DNA검사대병조시부잔류혹복발적양성예측치위60.0％,음성예측치100％,령민도100％,특이도52.9％,양성사연비위2.1,음성사연비위0.5,비수비위4.5.결론 대우HSIL차LEEP술후절연루급적환자,술후복사LCT화(혹)HR-HPV DNA가성위량항연합검험감측방법.대결과유이상화양성적병례,가재차음도경검사중신평고관경병변정도,위2차수술제공의거.
Objective To explore the value of cervical liquid-based cytology test (LCT) and high-risk human papilloma virus for patients of high-grade squamous intraepithelial lesion (HSIL) excised with positive margins by loop electrosurgical excision procedure (LEEP).Methods A total of 404 HSIL patients with positive margins by LEEP and a follow-up of 12 months between June 2004 to April 2013 were recruited.The results of LCT,high-risk human papillomavirus (HR-HPV) DNA were analyzed retrospectively.According to the pathological diagnosis of re-operation,the results of LCT and HR-HPV DNA were analytically predicted for focal residue and recurrence.Results For patients with HSIL excised with positive margins by LEEP,the re-positive abnormality rate of LCT and/or HPV was 18.7％ and the sustained positive rate of LCT and/or HPV 51.1％.The significance prediction of LCT and HR-HPV DNA examination for persistent and recurrent cervical dysplasia had a positive predictive value of 60％,a sensitivity of 100％,a positive likelihood ratio of 2.1,a negative likelihood ratio of 0.5 and an odds ratio of 4.5.Conclusion For patients of HSIL excised with positive margins by loop electrosurgical excision procedure,LCT plus HR-HPV test may be effective after operation.And the positive results should be reevaluated by colposcopy to provide rationales for re-operation.