195例子宫颈病变LEEP术后切缘状态及全子宫切除标本病变残留情况的分析

The state of resection margin after LEEP conization for cervical lesions and subsequent residual lesion after hysterectomy:a clinical study of 195 case

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 explore the state of resection margin after Loop electrosurgical excision procedure（LEEP） conization for cervical lesions and subsequent residual portion of lesions after hysterectomy.Methods：The relevant clinical data were collected during the period from Nov.2008 to June 2009,including 195 cases of hysterectomy after LEEP conization.The state of resection margin after LEEP conization was compared with the residual state of lesions after hysterectomy.Results：Out of 162 patients undergoing colposcopic biopsy,75.3% had the biopsy diagnosis equivalent to the pathological diagnosis,with 19.8% upgraded and 4.9 % downgraded in the grades of the lesion.Of the 195 cases,128 cases showed positive resection margin,while 67 cases showed negative and underwent hysterectomy due to other risk factors.No residual focus was found in 75.8% of the cases with positive resection margin after hysterectomy.The residual rate after hysterectomy corresponded directly to the resction margin of the lesion.The residual rates above HSIL were 13.2% and 19.6% when the margins were HSIL and CIS respectively,and the residual rate turned to be 21.7% if the cutting margin was microinvasive carcinoma and 70.0% for invasive carcinoma.Residual diseases were found in 5.97%（4/67）patients with negative margins.Conclusion：hysterectomy is not required as necessary treatment for those cases with positive resection margin except for positive invasive carcinoma,but further evaluation is a must.Standard LEEP with normal procedures may be conducive to reduce the proportion of positive resetion margin.