LLETZ治疗宫颈上皮内瘤变Ⅲ级临床疗效

The Clinical Efficacy of LLETZ for Grade Ⅲ Cervical Intraepithelial Neoplasia

目的评价宫颈移行区大环切除术(LLETZ)治疗宫颈上皮内瘤变(CIN)Ⅲ级的临床疗效。方法采用临床病例分析的方法,追踪观察北京大学深圳医院于2003年5月至2009年5月经液基细胞学检测(LCT)、高危型人乳头瘤病毒(HR-HPV)检测、阴道镜检查及阴道镜下多点活检病理诊断为CINⅢ而接受LLETZ手术的患者567例,对其术后随访、残留或复发等进行分析。以阴道镜下多点活检病理和LLETZ术后病理结果级别较高者作为最后诊断。对于随访中细胞学为低度鳞状上皮内瘤变及以上病变或未明确诊断意义的非典型鳞状上皮细胞伴HR-HPV阳性,及HR-HPV持续阳性者行阴道镜下多点活检,术后残留和复发均经病理学证实,分析手术后临床治愈、病变残留、复发等情况。结果①567例患者平均年龄(33.9±0.5)岁,随访时间(28.43±1.3)个月。②术前LCT异常率为94.77%,HPV感染率为97.70%。术后3个月HPV阴性率为88.18%,术后12个月HPV阴性率为90.30%。③CINⅢ术后6个月治愈率为98.24%,病变残留率为1.76%,术后1年复发率为0.53%,第2年复发率为0.28%,第3年复发率为3.05%,第4年无复发,第5年复发率为2.50%,第6年无复发;6年累积复发率为1.94%。结论 LLETZ治疗CINⅢ及Ⅰa1期子宫颈癌是一种安全有效的方法,在治疗的同时有明确诊断的作用,有助于HR-HPV感染的清除。

Objective To evaluate the clinical efficacy of large loop excision of the transformation zone （LLETZ） treatment in cervical intraepithelial neoplasia （CIN） grade 11I. Methods Clinical analysis was used to investigate 567 patients who were histopathologically confirmed CIN 111 by liquid cytological test, high-risk HPV testing, and rnuhiple-point biopsy under colposeopy and treated with LLETZ from Peking University Shenzhen Hospital from May 2003 to May 2009, and to analyze the residual or recurrence in follow-up. The final diagnosis was determined as the higher grade of either the colposcopie biopsy or the LLETZ histology result. Multi-point biopsy under colposcopy was performed when cytology result showed ASCUS and above lesions, and/or HR-HPV result showed positive in follow-up, residual and recurrence were confirmed by histo- pathology. The postoperative clinical effect, residual and recurrent lesions were analyzed during the follow-up. Results （~）The average age of the 567 cases was （ 33.9 ~ 0.5 ） year, and the average follow-up time was （ 28.43 ~ 1.3 ） month. （~）Preoperativc LCT abnormality was 94.77%, HPV infection rate was 97.70%. The total HPV-negative rate was 88. 18% 3 months after operation,HPV-negative rate 12 months after operation was 90.30%. （2）The overall cure rate was 98.24% 6 months after LLETZ, persistent residual lesion rate 1.76%. Recurrence rate of the 1 year after operation was 0. 53% , 2nd year was 0. 28%, 3nl year was 3.05% ,41h year was zero, 5th year was 2.50% , 6th year was zero. 6-year-cumulative-recurrence rate was 1.94%. Conclusion The treatment LLETZ of CIN 11I and Ial of ICC is a safe and effective method, which （：an treat the disease as well as clearly diagnose the disease,and promote the clearance of HR-HPV infection.