冷刀锥切诊治宫颈上皮内瘤样病变Ⅲ级120例随访分析

目的探讨冷刀锥切诊治宫颈上皮内瘤样病变Ⅲ级术后复发的高危因素。方法回顾性分析120例CIN Ⅲ级行宫颈冷刀锥切治疗的患者联合应用LCT和HR-HPV检测随访。结果 120例中复发5例,HR-HPV持续阳性占100%;LCT异常占60%;病理为宫颈管内病灶占60%;腺体受累占40%;HR-HPV阴性及术后转阴患者均无复发。结论 (1)HR-HPV持续感染、绝经后宫颈管内病灶及伴有腺体受累均为术后CIN复发的高危因素,同时有2个或以上高危因素患者复发几率增加。手术后HR-HPV转阴患者可排除复发的危险性。(2)LCT和检测HR-HPV不仅可以评价宫颈锥切治疗效果,而且可以作为术后追踪随访的有效手段。

Objective To determine factors predicting recurrent disease of cervical intraepithelial neoplasia Ⅲ（CIN Ⅲ） after excisional biopsy of the transformation zone（cold knife conization,CKC）.Methods We reviewed the data of 120 women who underwent CKC,using liguid-based cytologic test（LCT）and high-risk human papilloma virus（HR-HPV） test during subsequent follow-up.Results 5 cases of 120 performed recurrent disease,of which 100% HR-HPV persistant positive,60% LCT abnormal,60% ectocervical margin positive and 40% glandular extension;and none of the cases with negative HR-HPV pre-cone or after-cone developed recurrent disease.Conclusion（1）persistant infection of HR-HPV,positive endocervical margin and glandular extension are the high-risk factors to predict recurrent disease of CIN Ⅲ after conization,and two factors or more together increase the risk,HR-HPV negative after-cone could exclude the recurrent risk.（2）LCT and HR-HPV could not only evaluate the effect of cervical conization,but also be the effective follow-up methods after conization.