高级别宫颈上皮内瘤变治疗及转归预测因素的研究进展

Research Progress on Treatment and Prognosis Prediction of High-Grade Cervical Intraepithelial Neoplasia

研究已证实宫颈上皮内瘤变是宫颈癌的癌前病变,2014年世界卫生组织(WHO)改变了既往宫颈上皮内瘤变的3级分类法,将其分为低级别鳞状上皮内病变和高级别鳞状上皮内病变两类,其中宫颈高级别鳞状上皮内病变具有癌变潜能,极易进展,使我国女性的生理及心理健康受到严重威胁。目前,高级别鳞状上皮内病变的常用治疗方式为宫颈冷刀锥切术和环形电切术,一般疗效较好,但仍可能发生术中及术后出血、切口感染、宫颈狭窄、子宫内膜异位症和肠道损伤等并发症。相关研究显示,人乳头瘤病毒(HPV)分型、切缘阳性以及绝经状态与术后病变残留、复发、进展等风险密切相关,对宫颈锥切术后不良结局的预测有助于加强对此类患者的集中管理,提前预防并及时阻断病变进展途径,降低宫颈癌的患病率和死亡率。目前,预防性HPV疫苗的安全性和有效性已得到充分肯定,对减少HPV感染、预防术后疾病复发疗效显著,但宫颈已有病变者术后接种疫苗的作用效果尚待进一步探究。

Cervical intraepithelial neoplasia has been confirmed as a precancerous lesion of cervical cancer.In 2014,WHO changed the three-level classification of cervical intraepithelial neoplasia,dividing it into low-grade squamous intraepithelial lesions and high-grade squamous intraepithelial neoplasia.Among them,high-grade squamous intraepithelial lesions of the cervix have the potential to become cancerous and are prone to progress,which seriously threaten the physical and mental health of Chinese women.At present,the common surgical methods of cervical cold knife conization and circular electric resection are used to treat high-grade squamous intraepithelial lesions.Generally,good treatment results can be achieved,but intraoperative and postoperative bleeding and incision infection may still occur.Cervical stenosis,endometriosis,intestinal injury and other complications may also occur.Relevant studies have shown that human papillomavirus(HPV)classification,positive resection margins,and menopausal status are closely related to the risks of postoperative lesions,recurrence,and progression,which can help predict adverse outcomes after cervical conization,strengthen the centralized management of such patients,prevent and block the path of disease progression in advance,and reduce the prevalence and mortality of cervical cancer.At present,the safety and effectiveness of the preventive HPV vaccine have been fully affirmed,and it has significant effects on reducing HPV infection and preventing postoperative disease recurrence.However,the effect of postoperative vaccination in patients with cervical lesions needs to be explored.