LEEP治疗283例低度宫颈上皮内瘤变回顾性分析

摘要

目的 分析不同年龄段女性低度宫颈上皮内瘤变(CIN1及CIN1-2)宫颈环形电切术(LEEP)术后病理结果变化并结合术前患者HPV感染情况及年龄探讨≤30岁患者因CIN1或CIN1-2行宫颈环切术必要性.方法 回顾性分析2004年11 月～2009年12月妇科门诊阴道镜活检病理结果为CIN1级207例、CIN1-2级76例,比较≤30岁年龄及＞30岁年龄行LEEP后病理符合情况,同时对其中198例患者进行术前HPV-DNA检测,结合HPV-DNA分型检测结果分析198例患者术后病理升级率与HPV-DNA感染情况的关联性,同时比较CIN2及CIN3级患者LEEP术后病理符合情况.所有CIN1级及CIN1-2级患者均进行LEEP后6个月～2年的TCT及HPV检测随访.结果 年龄≤30岁CIN1和CIN1-2级患者LEEP术后病理符合率为25.86% (15/58),病理降级率60.34%(35/58),病理升级率13.79%(8/58);年龄＞30岁患者LEEP术后病理符合率为23.56% (53/225),病理降级率55.56%(125/225),病理升级率20.89%(47/225).CIN2及CIN3级患者LEEP术后病理符合率为23.42%(63/269),病理升级率为18.59%(50/269),病理降级率为57.99%(156/269).年龄≤30岁LEEP术后仍为CIN1及CIN1-2级者经过6个月～2年的TCT及阴道镜随访均为良性结果.198例术前行HPV检测患者中143例HPV-DNA(+)且术后病理升级率为27.27%(39/143),而HPV-DNA(-)患者术后病理升级率仅为5.45%(3/55).结论 阴道镜活检病理诊断为CIN1及CIN1-2级尤其HPV检测显示阴性且年龄≤30岁的患者,立即予LEEP术进行病灶切除存在一定的过度治疗,建议可结合患者躯体症状和心理需求予破坏性治疗(如电凝治疗或激光气化治疗等)或暂予TCT联合HPV-DNA进行跟踪随访.%Objective To analyze postoperative pathological result changes of females in different age groups who suffered from mild CIN1 as well as slight to moderate CIN1-2 grade.And to combine patients'preoperative HPV infection situation to investigate the necessity of carrying LEEP on young females(≤30 years) who has CIN1 or CIN1-2.Methods Retrospective analysis of pathological colposcopy biopsy was done with the outpatients from Nov.2004 to Dec.2009,207 cases CIN1,76 cases CINl-2.We compared the postoperative accordance situation between females(≤30) and females(>30) as well as between CIN2 grade patients and CIN3 grade patients,to analyze the relatedness of the 198 patients'postoperative pathological progression rate and HPV-DNA infection situation,taking preoperative test on 198 cases among them,linking with HPV-DNA subtype test results.TCT and HPV detect following-up should be carried on to all CIN1 and CIN1-2 patients,6 months to 2 years after LEEP. Result For age group ≤30,whose colposcopic biopsy pathological result is CIN1 and CIN1-2 grade,the LEEP postoperative pathological coincidence rate is 25.86%(15/58),pathological degradation rate is 60.34%(35/58),pathological progression rate is 13.79%(8/58);For female(>30),the LEEP pathology results of coincidence rate,compared to preoperative colposcopic biopsy results,is 23.56%(53/225),pathological degradation rate is 55.56%(125/225),pathological progression rate is 20.89%(47/225).For CIN2 and CIN3 grade patients,the LEEP postoperative pathological coincidence rate is 23.42%(63/269),pathological progression rate is 18.59%(50/269),pathological degradation rate is 57.99%(156/269).For those(≤30) whose LEEP postoperative results still remain CIN1 or CIN1-2 grade,after 6 months to 2 years'TCT and colposcopic follow-up,the result is benign.Of 143 cases in 198 patients who take preoperative HPV tests,HPV-DNA shows positive and postoperative progression rate is 27.27%(39/143),while the pathological progression rate of HPV-DNA negative patients is only 5.45%(3/55).Conclusion For patients whose colposcopic biopsy pathological diagnosis is CIN1 and CIN1-2 grade,especially those over 30 and HPV test turned out to be negative,LEEP or other treatment should be carried out for focal excision immediately.Overtreatment may exist.Under this circumstance,recommendations can be combined with patients' somatic symptoms and psychological needs to give destructive treatments(such as electric coagulation therapy or laser vaporization treatment,etc.),or temporarily TCT combined with HPV-DNA for following-up and tracking work.