宫颈癌前病变LEEP术后随访的方案探讨

The scheme of follow-up of cervical precancerous lesions after LEEP

目的探讨宫颈癌前病变术后随访的方案。方法将2006年1月～2011年12月间CINⅡ～Ⅲ在我院行宫颈LEEP手术病例共128例分为观察组和对照组,随访方案为观察组术后4个月开始,细胞学+HPV(HC2),细胞学诊断异常或HPV(HC2)阳性,行脱落细胞Ki67、P16免疫组化检测,若两项阳性则同时行阴道镜检查,图像异常时行活检病理诊断。对照组随访开始时间相同,细胞学+HPV(HC2),细胞学诊断异常或HPV(HC2)阳性则行阴道镜检查,图像异常行活检病理诊断,以病理结果为最后的标准。结果观察组活检人次明显减少,有极显著性差异(P<0.01)。活检阳性率有极显著性差异(P<0.01)。结论宫颈癌前病变术后采用细胞+HPV+Ki67、P16免疫组化检测随访方案,能明显减少活组织取材人次,提高活检阳性率,减少损伤。

Objective To investigate the cervical precancerous lesion follow-up scheme.Methods In 2006.1-2011.12 there are 128 cervical LEEP operation cases （CINⅡ-Ⅲ ）in our hospital, randomly divided into observation group and contrast group to follow up. Observation group test exfoliated cells Ki67, P16 were detected by immunohistochemistry if the follow-up contents HPV （HC2） positive or cytological diagnosis of abnormal from 4 months after operation.Both results are positive also give the vaginoscopy detect and continue to have the cervical biopsy to diagnosis if the image is abnormal.Contrast group start at the same time .They were given the cytological diagnosis and HPV（HC2） test,and to have the vaginoscopy detect if one result positive or both.We give the cervical biopsy to diagnosis if the image is abnormal and the result as the final standard. Results The cervical biopsy of the patients in observation group was significantly reduced in the inspection level of α=0.05 and the chi-squared x^2=6.75 （P 〈 0.01） and the positive rate of biopsy was significantly improved in the inspection level of α=0.05 and the chi-squared x^2= 8.11（P 〈 0.01）. Conclu- sion Apply cytology, HPV and ki67, P16 immunohistochemical detection to cervical precancerous lesions after operation can significantly reduce the number of living tissue specimens, improve the positive biopsy rate, reduce the damage, and improve the accuracy of diagnosis.