摘要
目的探讨高度宫颈上皮内瘤变经环形电切术(LEEP)后病情复发的危险因素及其在随访过程中的检测手段。方法通过回顾性分析我院2008-2010年经LEEP手术治疗且通过病理切片证实为CINⅡ或CINⅢ的250位患者术前高危型HPV DNA以及液基细胞学(TCT)情况,术后24个月,利用高危型HPV DNA基因型预测、P16inkta过表达检测、术前术后相同HR-HPV基因型预测等手段进行随访调查,根据所得结果并结合临床病理学特点,分析TCT、HPV DNA与高度宫颈上皮内瘤变复发的关系,并探讨高危HPV检测,P16inkta过表达及TCT检测作为随访检查手段的效果。结果 250例患者在经过24个月的随访检查后发现有25例复发,复发率为10%。手术病理切缘结果、宫颈管搔刮术结果、手术后TCT结果、手术后HR-HPV结果、P16inkta检测结果在复发组与未复发组比较差异有统计学意义(P<0.01);基因同型与不同型者复发率分别为85%、12%,两者比较差异有统计学意义(P<0.01);术后随访时,手术前后HPV基因型别是否相同和手术后HR-HPV检查敏感度最高,而P16inkta检测的特异性最好。结论宫颈管搔刮阳性和手术病理切缘阳性是LEEP术后复发的重要危险因素,术后随访采用术前术后相同HR-HPV基因型预测以及P16inkta过表达检测、HPV DNA预测复发结合TCT检查十分重要,可以有效地提高手术后复发预测的准确率。
Objective To investigate the risk factors for recurrence of high-grade cervical intraepithelial neo- plasia after LEEP and the detection methods in the follow-up process. Methods A group of 250 preoperative patients in our hospital from 2008 to 2010 after LEEP who was confirmed CIN ]I and CIN II[ by pathology were analyzed ret- rospectively for HPV DNA and TCT. 24 months after LEEP, high risk HPV DNA gene prediction, P16inkta overex- pression detection, and the same HR-HPV genotyping prediction were used for the follow-up examination. The corre- lation between TCT, HPV DNA and the recurrence of high-grade cervical intraepithelial neoplasia was investigated, and the effect of high risk HPV DNA gene prediction, P 16inkta overexpression, and TCT as methods for follow-up ex- amination. Results After 24 months of follow-up, in all of the 250 patients, there were 25 cases of recurrence, with the recurrence rate of 10%. The difference of the cutting edge surgical pathology, endocervical curettage, TCT results and post-operative HR-HPV, P16inkta test results between the recurrence group and non-recurrence group was statisti- cally significant （P〈0.01）. The recurrence rates for genes of the same type and different type were 85%, 12%, respec- tively, with statistically significant difference （P〈0.01）. In postoperative follow-up, the HPV genotypes before and af- ter surgery and post-operative HR-HPV checking had the highest sensitivity, and Pl6inkta showed the highest specific- ity of detection. Conclusion Cervical canal curettage positive and operation pathology positive margin are important risk factors of recurrent LEEP after operation. Postoperative follow-up with same HR-HPV genotyping prediction, P16inkta overexpression detection, HPV DNA gene prediction combined with TCT examination are very important, which can effectively improve the accuracy rate of recurrence prediction after operation.
出处
《海南医学》
CAS
2013年第24期3635-3638,共4页
Hainan Medical Journal
关键词
宫颈上皮内瘤样变
环形电切术
复发
预测因素
Cervical intraepithelial neoplasia
LEEP
Recurrence
Predictive factors
