宫颈上皮内瘤变患者环形电切术术后复发的影响因素分析

Influencing factors of recurrence in patients with cervical intraepithelial neoplasia after loop electrosurgical excision procedure

目的分析宫颈上皮内瘤变（CIN）患者环形电切术（LEEP）术后复发的影响因素。方法选取经宫颈细胞学和宫颈活组织病理学检查确诊为CIN并采用LEEP治疗的患者为研究对象。对患者术后进行随访，通过宫颈细胞学和阴道镜检查，发现异常则进行阴道镜下活组织病理学检查确诊。高危型人乳头瘤病毒（HPV）检测采用杂交捕获HPV DNA检测技术HC-2。术后6个月以上检测到与术前相同或更高级别的病变判定为复发。结果共收集符合要求的病例451例，年龄19～68（39．0±7．4）岁。病理学分级CINⅠ级122例，CINⅡ～Ⅲ级329例。共检出98例复发病例，复发率为21．73％（98，451），其中CINI级的复发率为14．75％（18／122），CINⅡ-Ⅲ级的复发率为24．32％（80，329）。单因素分析显示高危型HPV感染、术后切缘、病理学分级和宫颈细胞学改变是CIN患者LEEP术后复发的影响因素（P〈0．01或〈0．05）。多因素分析显示影响CIN患者LEEP术后复发的因素依次为高危型HPV感染、宫颈细胞学改变、术后切缘和病理学分级。结论高危型HPV感染是CIN患者LEEP术后复发的高危影响因素，宫颈细胞学改变、术后切缘和病理学分级也是影响LEEP术后复发的重要因素。

Objective To analyze influencing factors of recurrence in patients with cervical intraepithelial neoplasia （CIN） after loop electrosurgical excision procedure （LEEP）. Methods CIN patients who diagnosed by cervical cytology and cervical pathologic examination were treated with LEEP. Follow-up by cervical cytology and colposcope examination,patients with abnormal cytology were given colposcope pathologic examination. High risk human papilloma virus （HPV） was examined by hybrid capture HPV DNA method HC-2. Recurrent dis＇ease was defined when the same or higher level of lesion 6 months after LEEP were found. Results A total of 451 LEEP was performed during the study period, the age was 19 -68 （39.0±7.4） years. Pathological grading：CIN Ⅰ was in 122 patients,CIN Ⅱ -Ⅲ was in 329 patients. Ninety-eight patients were recurrent,the rate of recurrence was 21.73% （98/451）,the rate of recurrence in CIN Ⅰ was 14.75%（18/122）,in CIN Ⅱ -Ⅲ was 24.32%（80/329）. Single factor analysis showed that high risk HPV infection,surgical margin,pathological grading,cervical cytology abnormal changes were the influencing factors of recurrence after LEEP （P 〈 0.01 or 〈 0.05）. Multi-factor analysis showed that the influencing factors of recurrence after LEEP were followed by high risk HPV infection, cervical cytology abnormal changes, surgical margin and pathological grading. Conclusions High risk HPV infection is an important influencing factor of recurrence after LEEP in patients with CIN,and cervical cytology abnormal changes, surgical margin and pathological grading are also influencing factor of recurrence after LEEP.