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目的:探讨宫颈病变LEEP术后切缘状态以及全子宫切除标本中病变残留情况。方法:收集2008年11月至2009年6月本院195例LEEP术后行全子宫切除术病例的临床病理资料,对比分析其LEEP术后切缘状态及全子宫切除标本病变残留情况。结果:在本院行阴道镜下多点活检组织学诊断的162例患者,其活检诊断与LEEP术后病理诊断的总体完全符合率为75.3%,LEEP术后病理诊断升级者占19.8%,降级者占4.9%。195例患者中,128例因LEEP切缘阳性行全子宫切除术,67例切缘阴性者因其他高危因素行全子宫切除术。128例LEEP切缘阳性患者中,75.8%未在全子宫切除标本中发现任何上皮内病变;当LEEP切缘为HSIL、CIS、微小浸润癌和浸润癌时,子宫颈中HSIL以上程度病变残留率分别为13.2%、19.6%、21.7%和70.0%,HSIL以上程度的病变残留率随LEEP切缘病变程度增加而升高。67例LEEP切缘阴性者的全子宫切除标本中,4例(6.0%)发现残留病灶。结论:除LEEP切缘为浸润癌阳性,其它阳性切缘状态并非必须行全子宫切除术,而需进一步评估。规范LEEP过程可能有助于减少阳性切缘比例。
Objective: To investigate the status of the margins of LEEP after cervical lesion and the remaining lesions in the whole hysterectomy specimens. Methods: The clinical and pathological data of 195 cases of LEEP after hysterectomy in our hospital from November 2008 to June 2009 were collected. The margins of LEEP and the total residual hysterectomy were collected. Results: The biopsy histopathological diagnosis of 162 patients in our hospital with biopsy diagnosis and LEEP postoperative pathological diagnosis of the overall overall compliance rate was 75.3%, LEEP postoperative pathological diagnosis upgrade accounted for 19.8%, downgrade Who accounted for 4.9%. Of the 195 patients, 128 had a hysterectomy for LEEP positive margins and 67 had negative margins for hysterectomy due to other risk factors. Of the 128 LEEP-positive patients, 75.8% did not find any intraepithelial lesion in the hysterectomy specimens; when the LEEP margin was HSIL, CIS, micro-invasive carcinoma and invasive carcinoma, the residual rate of HSIL in the cervix 13.2%, 19.6%, 21.7% and 70.0% respectively. The residual rate of lesions above HSIL increased with the increase of LEEP margins. Of the 67 hysterectomies with negative LEEP margins, four (6.0%) had residual lesions. CONCLUSION: In addition to LEEP margins for invasive cancer-positive, other positive margins state is not necessary hysterectomy, and need further evaluation. Regulating the LEEP process may help reduce the proportion of positive margins.