诊断性LEEP术在HPV16持续感染合并LSIL患者随访中的价值

Study on the significance of diagnostic LEEP in follow-up of persistent HPV16 infection in patients with LSIL

目的探讨诊断性宫颈电刀切除术(LEEP)在人乳头状瘤病毒16(HPV16)持续感染合并低级别鳞状上皮内瘤变(LSIL)随访中的价值。方法回顾性分析2013年6月至2015年6月在上海市浦东新区人民医院妇科门诊收治的阴道镜下活检病理诊断为宫颈上皮内瘤变(CIN)Ⅰ级的LSIL合并HPV16持续感染的159例患者的病例资料。将患者按处理方法分为两组,随访组(n=88)以阴道镜继续随访观察为主,LEEP组(n=71)采用诊断性LEEP术治疗。比较两组阴道镜活检的病理结果符合率和转归结局差异。结果 LEEP组71例患者中,阴道镜活检病理诊断符合率为78.9%,诊断不足者为21.1%。与LEEP病理诊断结果比较,绝经、宫颈Ⅱ～Ⅲ级转化区类型、累及腺体的CINⅠ级患者阴道镜活检的诊断符合率分别是71.1%、51.7%、60.9%,较非绝经妇女、阴道镜CINⅠ级型转化区、不累及腺体的CINⅠ级病理诊断符合率(92.3%、97.6%、87.5%)明显降低(P<0.05)。LEEP术后随访2年,LEEP组的转归消退为57.7%,持续为42.3%,进展为0,较随访组(消退28.4%,持续61.4%,进展10.2%)结局明显改善(P<0.05)。诊断性LEEP术组HPV16转阴率为87.3%,术后持续阳性率为8.5%,复发或合并其他HR-HPV感染4.2%,较随访组病毒转阴28.2%,持续71.8%(P<0.05)结局改善明显。结论对于HPV16持续感染合并LSIL患者,阴道镜随访确诊CINⅠ级尚不够可靠,诊断性LEEP术有助于提高诊断的准确率,改善预后。绝经、阴道镜下宫颈暴露不充分、宫颈Ⅱ～Ⅲ级转化区类型、病变累及腺体等成为诊断性LEEP术后病理诊断与阴道镜诊断不符的高危因素。

Objective To explore the significance of diagnostic LEEP in patients with persistent human papillomavirus 16(HPV16)infection combined with LSIL and its following-up.Methods The clinical data of 159 patients with HPV16 persistent infection and low-grade squamous intraepithelial lesion(LSIL)diagnozed as CIN I by bioptic pathological examination under colposcopy in this hospital during February 2013 to February 2015 were retrospectively analyzed,they were divided into 2 groups according to randomized numeracal method,follow-up group(n=88)was subjected to follow-up,and LEEP group(n=71)by using diagnostic LEEP for treatment.The coincidence rate between colposcopy and postoperative pathological results were compared,and the difference on outcome between these two groups was also compared.Results The results of colposcopy in 71 cases of LEEP group were diagnosed as CIN I,the diagnostic coincidence rate was 78.9%,and the inadequate diagnosis rate was 21.1%.In comparison with pathological diagnosis of LEEP,the accordance rate of menopause,transformation zone ofⅡ,Ⅲ,CINⅠinvolving glands by colposcopy were 71.1%,51.7%and 60.9%respectively,which were significantly lower than those of 92.3%,97.6%and 87.5%in nonmenopause women,transformation zone of gradeⅠ,CINⅠwithout involving glands(P<0.05).Following up for 2 years after LEEP,the outcome in LEEP group was 57.7%,continuous lesions was 42.3%,advance was 0,and they were obviously better than those of 28.4%,61.4%and 10.2%in follow-up group(P<0.05).The disappearance rate of HPV16 in diagnostic LEEP group was 87.3%,postoperative continuous positive rate was 8.5%,and the recurrence or combination with other HR-HPV infection was 4.2%,which was significantly improved than 28.2%and 71.8%of follow-up group(P<0.05).Conclusion Colposcopy is still not reliable in patients with HPV16 persistent infection and LSIL,diagnostic LEEP helps to raise the diagnostic accuracy and prognosis.Menopause,cervical inadequate exposure under colposcopy,cervical transformation area of typeⅡ-Ⅲ,lesions involved glands diagnostic LEEP were the risk factors of inconsistent diagnosis between colposcopic diagnosis and postoperative pathological diagnosis after diagnostic LEEP.