中山大学学报（医学科学版）2012，Vol.33Issue(5)：619-624,6.
高度宫颈上皮内瘤变电环切术后复发的预测因素
Predictors for Recurrence of High-grade Cervical Intraepithelial Neoplasia (CIN) after Loop Electrosurgical Excision Procedure (LEEP)
摘要
Abstract
[Objective] To investigate the risk factors connected to recurrence of high-grade cervical intraephethial neoplasia (CIN Ⅱ/Ⅲ) after loop electrosurgical procedure (LEEP) and evaluate the methods to follow up. [Methods] Analysis was performed with 203 cases who underwent a LEEP and were pathologically confirmed CIN II /HI in the Second Affiliated Hospital, Sun Yat-sen University from January 2007 to January 2009. Preoperative liquid-based cytological tests (LCT), high-risk HPV DNA (HR-HPV), clinicopathologic features were analyzed. The cases were followed up as long as 24 months after LEEP. LCT, HPV DNA were performed at the sixth, twelfth, eighteenth, and twenty-forth month after LEEP. Colposcopy and biopsy and endocervical curettage (ECC) were performed in case of either of LCT or HR-HPV DNA was positive. All of the cases who were followed up with negative results in LCT and HPV DNA were performed with colposcopy and biopsy and ECC at the 24th month after LEEP. [Results] An analysis of 203 patients who underwent a LEEP and pathologically confirmed CIN II/III were performed. Eighteen patients were proved recurrence in the period of 24 months of follow-up with a recurrent rate of 7.0%. Margin involved and positive ECC were associated with recurrence (P < 0.01). Patients with margin involved had a recurrent rate of 20.8% while those without had a recurrent rate of 4.7%. Patients with positive ECC had a recurrent rate of 29.1% while those without had 4.7%. Sensitivity, specificity, positive predictive value and negative predictive value in follow up LCT and HR-HPV were 72.2% and 94.4%, 81.6% and 86.9%, 27.7% and 42.5%, 97.4% and 99.3%, respectively. In the same HR-HPV genotype pre-and post-procedure, Sensitivity, specificity, positive predictive value and negative predictive value were 94.1%, 95.7%, 94.1%, and 95.7%. Compared with HR-HPV DNA, the same HR-HPV type pre- and post-procedure had the equal sensitivity and negative predictive value but higher specificity and positive predictive value. [Conclusions] Margin involved and positive ECC are risk factors for recurrence after LEEP. Besides LCT and HR-HPV DNA, the same HR-HPV genotype pre- and post-procedure is an important predictive factor for recurrence during follow up.关键词
宫颈上皮内瘤样变/环形电切术/乳头瘤病毒,人/基因分型/复发/预测因素Key words
cervical intraepithelial neoplasia/ loop electrosurgical excision procedure (LEEP)/ papillomavirus, human/ genotype/ recurrence/ predictive factor分类
医药卫生引用本文复制引用
彭永排,周晖,卞丽娟,卢淮武,张丙忠,林仲秋..高度宫颈上皮内瘤变电环切术后复发的预测因素[J].中山大学学报（医学科学版）,2012,33(5):619-624,6.基金项目
国家自然科学基金(30872743) （30872743）
广州市科技计划项目(2010J-E291) （2010J-E291）
