【摘要】 目的:分析宫颈移行区大环切除术(LLETZ)治疗宫颈上皮内瘤变Ⅲ级(CINⅢ)及ⅠA1期子宫颈癌术后病变残留与复发的相关因素。方法:选取2003年5月至2009年5月在我院经子宫颈癌"三阶梯"诊断步骤诊断为CINⅢ并行LLETZ手术的567例患者,追踪观察其术后随访情况,探讨术后病变残留与复发的相关因素。结果:(1)567例患者的阴道镜活检病理结果均为CINⅢ,LLETZ术后病理诊断为CINⅠ、CINⅡ、CINⅢ、ⅠA1期子宫颈癌者分别为21例、65例、433例、48例。定期随访12～72个月,547例患者的总残留率与复发率分别为1.76%和1.94%。术后病理切缘为CIN者共46例,其中CINⅠ17例、CINⅡ13例、CINⅢ16例;切缘无病变者521例。(2)LLETZ术后病理切缘阳性与切缘无病变者的术后病变残留率、术后复发率均无显著差异(P>0.05),但术后HPV持续感染率有显著差异(P<0.05)。4例切缘为CINⅢ者术后1个月再行LEEP术者与46例单纯随访观察者的术后病变残留率及复发率均无显著差异(P>0.05);但切缘残留CINⅢ病变者的术后病变残留率及复发率均高于CINⅠ/Ⅱ及再行LEEP手术者。(3)术后HPV持续阳性者的复发率显著高于非HPV持续感染者(P<0.05)。结论:(1)LLETZ术切除标本切缘病理对预测病变残留、复发有临床价值,且与术后HPV持续感染密切相关,但切缘状态并不是患者行二次手术的唯一指征。(2)术后HPV持续阳性者的复发率增高,临床需严密随访。更多还原

【Abstract】 Objective:To analyze the related factors to residual/recurrent lesions in cervical intraepithelial neoplasia grade Ⅲ(CINⅢ) and ⅠA1 of ICC after large loop excision of the transformation zone(LLETZ).Methods:Tracing observe the patients who were histopathologically confirmed CINⅢ by the "three steps" cervical cancer diagnostic steps and treated with LLETZ from May 2003 to May 2009,and to investigate the postoperative residual or recurrent lesions.To analyze related factors to residual and recurrent lesions.Results:(1)Colposcopic biopsies were all CINⅢ,LLETZ biopsies diagnosis of CINⅠ,CINⅡ,CINⅢ and ⅠA1 of ICC were 21 cases,65 cases,433 cases and 48 cases.10 residual lesions and 11 recurrent lesions were diagnosed after LLETZ.46 cases involved margins were found,of which 17 cases were CINⅠinvolved margins,13 cases were CINⅡinvolved margins,16 cases were CINⅢ involved margins.521 cases were clear margins.(2)Postoperative the residual lesion rate and recurrence rate were still higher in involved margin patients than in clear margin patients,while there was no statistically significance(P>0.05).Postoperative persistent HPV infection between the two groups showed statistically significance(P<0.05).Postoperative residual lesion rate and the recurrence lesion rate in re-leep patients and follow-up patients with involved margins showed no statistically significance(P>0.05),while postoperative residual lesion rate was slightly higher in CINⅢ involved margins than in CINⅠ/Ⅱinvolved margins and re-leep patients;the recurrence lesion rate was slightly higher in CINⅡ/Ⅲ involved margins than in CINⅠinvolved margins and re-leep patients.(3)The recurrence lesion rate was higher in postoperative persistent HPV infection patients,and showed statistically significance(P<0.05) compared with non-postoperative persistent HPV infection patients.Conclusions:(1)Margin status can help predict postoperative residual lesion and recurrence lesion and show its clinical value,and is related to postoperative persistent HPV infection,but it is not the only indication for second surgery in patients with involved margins.(2)The recurrence lesion rate is increased in postoperative persistent HPV-positive patients,and need close follow-up.更多还原