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目的探讨宫颈环形电切术(LEEP)后切缘状态与病情转归的关系,为高危切缘阳性患者预测病情进展提供依据。方法收集该院2013年4月-2014年4月诊断为宫颈上皮内瘤样变(CIN)患者120例,均符合LEEP的手术指证并签署知情同意书,术后对患者切缘情况进行观察,分为切缘阴性组及阳性组,对2组患者年龄、病程、CIN分期、HPV阳性率进行比较,对切缘阳性与HPV阳性的相关性进行比较。结果患者切缘状态分析发现,切缘呈阳性共43例,阴性77例,阳性组与阴性组患者的年龄、病程和CIN分级比较,差异均无统计学意义(t=0.167、0.576、0.627、0.799和0.648,P>0.05);阳性组患者人乳头瘤病毒(HPV)阳性率显著高于阴性组,差异有统计学意义(χ2=6.127,P<0.05),切缘阳性与HPV阳性呈正相关(r=0.627,P<0.05)。切缘阳性同时HPV阳性患者发生病情恶化的比例最高,其次为切缘阳性同时HPV阴性,切缘阴性同时HPV阳性病情恶化次之,切缘阴性同时HPV阴性患者的病情转归最好,组间比较差异有统计学意义(χ2=5.247,P<0.001)。结论 LEEP切缘阳性与病变严重程度及CIN病变残留具有一定联系,术后同一高危亚型HPV需警惕CIN病变的持续进展,减少宫颈浸润癌的发生。
Objective To investigate the relationship between the status of margins and the prognosis of patients after the operation of cervical ring excision (LEEP), and to provide a basis for predicting the progression of the disease in patients with positive margins. Methods A total of 120 patients with cervical intraepithelial neoplasia (CIN) who were diagnosed as CIN from April 2013 to April 2014 were enrolled in the study. All of them were in compliance with the LEEP surgical indication and signed the informed consent. The patients’ margins were observed after operation, The patients were divided into negative group and positive group. The age, course of disease, CIN staging and HPV positive rate were compared between the two groups, and the correlation between positive and HPV positive was compared. Results There were 43 cases with positive margins and 77 cases with negative margins. There was no significant difference in age, course of disease and CIN grade between the positive and negative groups (t = 0.167, 0.576, 0.627, 0.799 and 0.648, P> 0.05). The positive rate of HPV in positive patients was significantly higher than that in negative patients (χ2 = 6.127, P <0.05) (r = 0.627, P <0.05). The positive rate of HPV-positive patients was the highest, followed by positive HPV-negative patients, negative HPV-positive patients, followed by negative HPV-positive patients, negative HPV-positive patients and negative HPV-negative patients. The difference was statistically significant (χ2 = 5.247, P <0.001). Conclusions The positive LEEP margins correlate with the severity of the lesion and residual CIN lesions. The same high-risk subtype of HPV should be cautious about the continuous progression of CIN and reduce the incidence of invasive cervical cancer.