【摘要】 目的探讨宫颈环形电切术(LEEP)后宫颈上皮内瘤变(CIN)且切缘阳性患者病灶的残留情况。方法回顾性分析62例LEEP后CIN且切缘阳性并行子宫全切术患者的病理资料,将LEEP后病理与子宫全切术后病理进行比较。结果 62例LEEP后CIN且切缘阳性的患者子宫全切后病灶残留率达56.5%(35/62)。单内切缘、单外切缘阳性和内外切缘皆阳性患者的病灶残留率比较,差异无统计学意义(P>0.05)。LEEP后切缘阳性部位与子宫全切后CIN不同级别的分布间差异有统计学意义(H=2.41,P<0.05)。LEEP后切缘阳性CINⅡ级和CINⅢ级患者子宫全切后宫颈残留CIN病变的程度比较,差异无统计学意义(P>0.05)。LEEP后切缘阳性的CINⅡ级和CINⅢ级患者,单内、单外切缘阳性和内外切缘皆阳性者宫颈腺体累及率比较,差异均无统计学意义(P>0.05)。结论 LEEP后CIN且切缘阳性患者的后续处理需要综合评估,采取合适的措施,对内外切缘皆阳性患者要采取积极的治疗措施,宫颈病变的严重程度不能预测LEEP后是否有病灶残留;宫颈腺体累及率与病变的严重程度和切缘阳性部位无关。更多还原

【Abstract】 Objective To explore the residual lesions in patients with cervical intraepithelial neoplasia(CIN) with positive resection margin after loop electrosurgical excision procedure(LEEP). Methods The pathological data of 62 CIN patients who had undergone both LEEP with positive resection margin and total hysterectomy were retrospectively reviewed,and the pathological findings after LEEP and after total hysterectomy were compared. Results The rate of residual lesion after total hysterectomy was 56.5%(35/62) in CIN patients with positive resection margin after LEEP.The rate of residual lesion were not significantly different among patients with positive margin(s) at internal positive resection margin,exterior positive resection margin,and exterior and interior positive resection margins(P>0.05).There were significant difference between the locations of positive margins after LEEP and the distribution of CIN grade after total hysterectomy(H=2.41,P<0.05).The severity of residual CIN lesions was not significantly different between patients with CINⅡ and those with CIN Ⅲ after total hysterectomy(P>0.05).In addition,in patients with CIN Ⅱ or Ⅲ,the glandular involvement rate of the cervix also showed no significant different among patients with internal positive resection margin,exterior positive resection margin,and exterior and interior positive resection margin(P>0.05). Conclusion The management for post-LEEP CIN patients with positive margin should be carefully assessed and performed.Patients with exterior and interior positive margins should be actively treated.The severity of the cervix lesion can not predict the potential existence of residual lesion after LEEP.The glandular involvement rate and severity of the cervix lesion are not relevant with the position of positive margin.更多还原