【摘要】 目的探讨宫颈环形电切术(LEEP)的诊断价值及宫颈上皮内瘤变Ⅲ(CINⅢ)和宫颈鳞癌Ia1期术后病变残留的危险因素。方法 CINⅢ和Ia1期宫颈鳞癌患者52例,回顾性分析阴道镜下活检、LEEP及子宫切除CIN病理结果,探讨宫颈环切切缘、LEEP术前高危型人乳头状病毒(HR-HPV)载量与病变残留的关系。结果切缘阴性者病变残留率为34.6%,切缘阳性者为57.7%(P>0.05)。无病变残留者LEEP术前HR-HPV载量中位数为28.82,明显低于有病变残留者的640.97(P<0.05)。ROC曲线发现当切缘阴性且HR-HPV≤64.11时,病变残留的阴性预测值为100.0%;当切缘阳性且HPV≥17.59时,病变残留的阳性预测值为66.7%。结论 CIN及Ia1具有多病灶共存的特性,LEEP可避免遗漏严重病变;合理应用术前HR-HPV病毒载量结合切缘状态,可为临床处理提供依据。更多还原

【Abstract】 Objective To discuss the value of loop electrosurgical excision procedure(LEEP) and assess the risk factors of residual disease of cervical intraepithelial neoplasia Ⅲ(CIN Ⅲ) and Ia1 after LEEP.Methods The medical records of biopsy,LEEP and pathology of hysterectomy within 1 month after LEEP were retrospectively analyzed in 52 patients with CIN Ⅲ and Ia1.The diagnosis of LEEP and the relationship between residual disease and excision margin,high risk human papilloma virus(HPV) before LEEP were investigated.Results The rates of residual disease in the cases with positive and negative margins were 57.7% and 34.6%)(P>0.05).The median HPV load before LEEP in 52 cases with no residual disease(28/52) was 28.82,which was significantly lower than 640.97 in those with residual disease(P<0.05).The ROC curve showed that when the margin was negative and HR-HPV≤64.11,the negative predictive value is 100%,and when the margin was positive and HR-HPV>17.59,the positive predictive value was 66.7%.Conclusion Cervical squamous cancer in stages of CIN and Ia1 has a feature of multilesions coexistence.Examining the HPV load before LEEP and excision margin is helpful in managing cervical squamous cancer in stages of CIN Ⅲ and Ia1.更多还原