LEEP治疗宫颈上皮内瘤变后高危型HPV的变化及意义

目的:探讨各级别宫颈上皮内瘤变(CIN)经宫颈环切术(LEEP)治疗前后高危型人乳头瘤病毒(HR-HPV)的变化规律及临床意义。方法:各级别CIN且HR-HPV阳性患者155例,行LEEP术后6个月再次行膜式液基细胞学检查(TCT)并测定HR-HPV负荷量。结果:(1)CINⅠ、CINⅡ、CINⅢ病变HR-HPV负荷量(RLU/CO)分别为333.23±911.83,303.88±795.30及220.72±680.92,三者差异无统计学意义(P=0.6868);(2)术后6个月HPV总转阴率为62.58%(97/155)。术前HPV负荷量≤300者术后转阴率为71.60%(58/81),300者转阴率为52.70%(39/74),差异有统计学意义(P=0.0294)。并且术后病灶残留与术前高病毒负荷量相关。HPV清除率与年龄及病变程度无相关性;(3)术后6个月HPV负荷量≥10的患者中43.75%(14/32)的患者仍存在不同程度的CIN,而HPV10的患者中只有0.81%(1/123)的患者存在CIN,以10为阈值判断病灶残留的敏感性达93.33%,特异性达87.14%。结论:(1)HPV负荷量高低与病变程度无关,但与术后病毒清除相关;(2)在切缘阴性的前提下,若术前高病毒负荷量,发生病灶残留的风险增高;(3)术后6月宫颈病变的转归与同期检测的病毒负荷量相关。     

TCT联合高危型HPV检测对218例CIN手术治疗后随访结果分析

目的:探讨液基细胞学检测技术(TCT)联合高危型人乳头瘤病毒(HPV)检测在宫颈上皮内瘤变(CIN)手术治疗后随访的意义.方法:对218例诊断为CIN Ⅰ～Ⅲ的患者,其中高危型HPV阳性206例,行LEEP治疗或宫颈冷刀锥切.术后严格进行TCT联合高危型HPV检测随访.结果:CIN Ⅰ组术后6月高危型HPV检测阳性为0,TCT未发现复发病例,治愈率为100％.术后第6个月,CINⅡ、Ⅲ组高危型HPV阳性率分别为14.89％和22.92％,显著高于CIN Ⅰ组,差异有统计学意义(P＜0.05).术后24月CINⅡ、CINⅢ组复查TCT所有病例均转为阴性,高危型HPV阳性率分别为1.06％、3.13％.结论:CIN手术治疗是高危型HPV转阴的主要治疗手段,TCT联合高危型HPV检测是CIN治疗后临床追踪随访的有效手段.     

阴道微环境和HPV感染与CIN的关系研究

目的 分析阴道微环境和人乳头瘤病毒（HPV）感染与宫颈上皮内瘤变（CIN）的关系。方法 选取180例CIN患者,其中CINⅠ级110例纳入LSIL组,CINⅡ～Ⅲ级70例纳入HSIL组;另选取同期正常健康180例作为对照组。分析CIN发生的影响因素。结果 Logistic回归分析显示：HPV感染、细菌性阴道病（BV）、霉菌性阴道炎（VVC）、白介素-2(IL-2)降低、白介素-4(IL-4)增高、干扰素-γ(IFN-γ)降低是LSIL发生的危险因素（P<0.05）;首次性交年龄<20岁、HPV感染、BV、滴虫性阴道炎（TV）、VVC、IL-2降低、IL-4增高、IFN-γ降低是HSIL发生的危险因素（P<0.05）。结论 宫颈CIN与阴道微环境、HPV感染均有密切关联,均会提高CIN的发生风险,临床应采取积极干预措施。     

不同亚型HPV感染情况及与CIN的关系研究

目的:探讨不同亚型HPV感染情况及与宫颈上皮内瘤变(CIN)的关系。方法:回顾性分析我院就诊的8640例行HPV检测的临床资料,统计不同亚型HPV感染情况及与不同级别CIN患者之间的关系,以及常见亚型HPV致病力的差异。结果:①HPV阳性1873例(21.7%),多重感染453例(5.24%),单一亚型感染1420例(16.44%),HPV检出频次2417次,检出频次最高的6种高危亚型分别为:HPV16(25.90%),HPV58(11.92%),HPV52(10.22%),HPV33(6.99%),HPV53(6.54%)和HPV18(5.63%)。372例CIN患者中有273例HPV阳性,其中检出频次最高的几个亚型:HPV16(57.51%),HPV18(16.48%),HPV58(13.92%),HPV52(9.16%),HPV33(8.79%)和HPV31(4.40%)。②检出频次较高的6种HPV亚型中,HPV52亚型发病年龄最低。③HPV16、HPV18亚型发生高级别CIN的风险较其他亚型更高(OR=24.056,OR=27.474);单一感染时,HPV16亚型感染导致CIN的发生率比HPV18亚型的高,且差异有高度统计学意义(P=0.003)。HPV58亚型感染导致CIN的发生率较HPV52亚型的高,且差异有高度统计学意义(P=0.003)。结论:CIN患者中感染HPV的常见亚型依次为:HPV16、18、58、52、33、31。HPV52亚型发病年龄低,致病力弱。在单一感染中HPV16亚型的致病力较HPV18亚型强,HPV58亚型的致病力较HPV52亚型强。     

LEEP治疗宫颈上皮内瘤变924例临床分析

目的探讨高频电波刀环形电切术（LEEP）在宫颈上皮内瘤变（CIN）诊治中的价值。方法回顾性分析2004年1月-2007年6月我院924例宫颈阴道镜下多点活检和LEEP治疗CIN患者的临床资料,比较阴道镜下多点活检和LEEP术后的病理结果。结果LEEP与阴道镜下多点活检的病理结果符合率为85．50％,其中14．50％（134／924）LEEP术后病理较阴道镜下多点活检程度重,43．83％（405／924）病理程度较阴道镜活检轻。LEEP术后,发现早期浸润癌4例（o．43％）;CINⅢ级累腺19例（2．06％）。随诊6～32个月,无一例复发。结论LEEP在治疗CIN中具有诊断和治疗的价值。     

辛复宁配合LEEP治疗宫颈上皮内瘤变临床观察

<正>宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)是宫颈癌前病变[1],目前证实CIN与HPV感染高度相关[2]。伴有病毒感染的CIN患者,采用普通抗生素或物理治疗往往难以彻底清除病毒。2009年1月～12月我院应用重组人干扰素α-2b阴道泡腾胶囊(辛复宁)配合LEEP治疗CIN,报道如下。     

CINⅡ～Ⅲ LEEP治疗后随访情况分析

目的探讨宫颈上皮内瘤样病变(CIN)Ⅱ～Ⅲ患者高频电波刀宫颈电圈环切术(LEEP)治疗的有效性.方法对CINⅡ～Ⅲ行LEEP手术的73例患者进行为期2～5年的随访,对手术后患者的病灶持续存在和复发等情况进行分析总结.结果6个月总的治愈率为97.26%,病变持续存在率2.74%,术后1年复发率为2.78%,2年时复发率为1.41%,3年、4年、5年无复发.其中CINⅡ33例,6月治愈率96.97%,病变持续存在率3.03%,1年复发率为0,2年复发率为3.23%;CINⅢ40例,6月治愈率为97.50%,病变持续存在率2.50%,1年复发率5.00%;CINⅡ、CINⅢ在治愈率、病变持续存在率、复发率方面比较差异无显著性(P＞ 0.05).结论LEEP对于CINⅡ～Ⅲ患者的治疗是安全、有效的,但需长期随访,尤其是术后前2年.     

LEEP术与海扶聚焦超声治疗CIN合并高危型HPV感染的疗效及转阴率观察

目的 比较宫颈环形电切术（LEEP）与海扶聚焦超声治疗宫颈上皮内瘤变（CIN）合并高危型HPV感染的临床疗效及转阴率。方法 选取60例CIN合并高危型HPV感染患者,依据治疗方法不同分为LEEP组（32例）与海扶组（28例）。LEEP组采用LEEP术治疗,海扶组采用海扶聚焦超声治疗。比较两组临床疗效及转阴率。结果 LEEP组治愈率为90.63%,HPV转阴率为93.75%;海扶组分别为89.29%、92.86%,比较差异无统计学意义（P>0.05）。海扶组阴道出血时间、阴道排液时间及宫颈创面愈合时间均明显短于LEEP组,阴道出血量、阴道排液量均明显少于LEEP组,差异有统计学意义（P<0.05）。结论 LEEP术与海扶聚焦超声治疗CIN合并高危型HPV感染效果与转阴率相当,但后者宫颈创面愈合速度更快,且术后阴道出血与排液现象更轻微,更具推广价值。     

HPV感染年龄与高度宫颈上皮内瘤变的关系

目的探讨高危型人乳头瘤病毒（HR-HPV）感染患者年龄分布与高度宫颈上皮内瘤变和宫颈癌的关系。方法 2008年7月至2009年4月在中日友好医院同时采用液基薄层细胞学（LCT）和HPV检测行宫颈癌筛查的妇女948例,对LCT≥ASC-US和/或HR-HPV阳性的367例患者进行阴道镜下宫颈活检。结果 〈50岁年龄组妇女的HR-HPV感染率（34.27%）与≥50岁年龄组妇女（18.98%）比较,差异具有统计学意义（P〈0.01）;〈30岁、30～49岁和≥50岁3个年龄组HR-HPV阳性者中,≥CIN2患者的例数分别为18例（39.13%）、81例（43.78%）和17例（32.69%）,差异无统计学意义（P〉0.05）。结论各个年龄段感染HR-HPV的妇女发生≥CIN2的机会无明显差异,均应加强随访。     

1955例武汉市农村妇女HPV感染状况与危险因素分析

目的:探讨武汉市农村妇女HPV在宫颈炎、宫颈上皮内瘤变(CIN)、宫颈癌中的感染分布情况及HPV感染危险因素。方法:在2011年武汉市20万农村妇女宫颈癌初筛阳性患者中随机抽取1955例,采用飞行时间质谱检测法对宫颈刷片进行HPV分型测定,分析HPV在宫颈炎、CIN、宫颈癌中的感染情况。结果:1955例宫颈刷片标本中发现HPV感染1115例,感染率为57.03%。HPV在不同宫颈疾病中的感染率不同,HPV在宫颈炎中的感染率为40.72%,CIN中为89.64%,宫颈癌中为92.86%,差异有统计学意义(P<0.01);HPV感染患者中,单纯高危型及单纯低危型HPV感染所占比例分别为92.74%、3.23%,差异有统计学意义(P<0.01)。1955例患者中HPV 16型感染率最高(18.16%),其次是HPV 58型(13.35%)、HPV52型(11.00%)、HPV 33型(5.68%)。1955例患者中单一亚型感染率为41.43%,双重及多重感染率为15.60%。不同初婚年龄、临床症状、宫颈癌家族史及是否熬夜等患者HPV感染率比较,差异有统计学意义(P<0.05)。结论:武汉市农村妇女高危型HPV感染是宫颈癌及CIN发生的必要因素。初婚年龄较早、有宫颈癌家族史、经常熬夜等为HPV感染的危险因素。     

宫颈上皮内瘤变LEEP治疗后转归相关因素分析

目的对宫颈上皮内瘤变患者在LEEP术后转归的影响因素进行探讨分析。方法回顾性分析内蒙古医科大学附属医院妇产科2008年1月至2010年12月,219例行LEEP手术的CIN患者,随访1年以上,收集所有相关资料,并进行单因素和多因素Logistic回归分析。结果多因素分析显示年龄≥50岁、高危HPV持续感染和LEEP术后标本切缘阳性、病变累及宫颈腺体是LEEP术后病灶复发的独立危险因素。结论 CIN患者经LEEP治疗前HR-HPV多重感染者治疗后复发率明显增高。年龄≥50岁、切缘阳性、高危HPV持续感染,累及腺体是影响LEEP术后CIN患者转归的危险因素。     

宫颈电圈环切术诊治宫颈上皮内瘤变的临床观察

目的探讨宫颈电圈环切术(LEEP)在诊治宫颈上皮内瘤变(CIN)中的作用。方法选择304例CIN患者作为研究对象,采用LEEP行宫颈锥切术,比较术前宫颈活检与术后病理结果,术后3个月和6个月复查宫颈薄层液基细胞学检测(LCT)、HPV结果。结果与术前活检结果相比术后病理结果降级占3.6%(11/304),相同占91.1%(277/304),升级占5.3%(16/304),浸润癌1例;切缘阳性率为3.9%(12/304)。LCT随访结果,术后3个月正常者99.3%;术后6个月正常者93.8%。HPV随访结果,术后3个月HPV阴性者占91.7%,术后6个月HPV阴性者占92.7%。结论LEEP是诊断及治疗CIN安全且有效的方法。     

液基薄层细胞学、活检病理和宫颈环形电切术(LEEP)诊断早期宫颈癌及宫颈上皮细胞内瘤样病变的比较研究

目的:比较细胞学、活检病理和宫颈环形电切术(loop electrosurgical excisional procedure,LEEP)病理诊断早期宫颈癌和宫颈上皮细胞内瘤样病变(cervicalintraepithelialneoplasia,CIN)的准确性。方法:回顾性比较分析201例进行LEEP患者术后病理、术前活检病理和液基薄层细胞学(thinprep cytologic test,TCT)3种诊断方法的检测结果。结果:201例LEEP术后组织病理分析显示92例(45.8%)患者具有CIN2~3病变及4例浸润癌患者,其中71例患者术前病理为CIN2及以上鳞状上皮内瘤样病变。在细胞学检查结果为LSIL的66例患者中活检病理和LEEP病理结果为CIN2及以上病变的分别有22例和23例。活检病理与LEEP病理符合率为86.5%,Kappa值为0.718。活检病理结果为CIN1的113例患者中有16例LEEP病理结果为CIN2及以上病变。结论:活检病理可以提高细胞学结果为LSIL的患者中宫颈高级别病变的诊断效率,对确定合理的LEEP术前指征具有重要的临床价值。     

Alterations in human papillomavirus-related biomarkers after treatment of cervical intraepithelial neoplasia

Objective

This study aims to assess the alterations in various HPV-related biomarkers 6 months post-treatment and how these relate to various risk factors and individual characteristics; their role for the prediction of treatment failure was also evaluated.

Material and methods

Design: Prospective observational study.Population: Women planning to undergo treatment for cervical intraepithelial neoplasia.Intervention: A liquid-based cytology sample was taken pre-operatively. This was tested for HPV genotyping, Nucleic Acid Sequence Based Amplification, flow cytometric evaluation and p16 immunostaining. A repeat LBC sample was obtained 6 months post-treatment and was tested for the same biomarkers.Outcomes: The alterations of the biomarkers 6 months post-treatment were recorded. Their relation to individual characteristics and risk factors (age, smoking, sexual history, use of condom, CIN grade, excision margin status, crypt involvement) as well as their role for the prediction of residual/recurrent disease were assessed.Analysis: The accuracy parameters (sensitivity, specificity, positive and negative predictive value and the likelihood ratios) of each biomarker for the prediction of recurrent/residual CIN were calculated.

Results

A total of 190 women were recruited. All biomarkers had significantly higher negativity rates post-treatment compared to pre-treatment ones. Multivariate analysis demonstrated that consistent condom use post-treatment significantly reduces the high-risk HPV positivity rates in comparison to no use (OR = 0.18; 95% CI: 0.09-0.38). Sensitivity and specificity for all high risk HPV DNA testing were 0.5/0.62, respectively; the relevant values for only type 16 or 18 DNA typing were 0.5/0.92, for NASBA 0.5/0.94, for flow 0.5/0.85 and for p16 0.25/0.93.

Conclusion

CIN treatment reduces positivity for all HPV-related biomarkers. Consistent condom use significantly reduces high-risk HPV positivity rates. More cases of treatment failures are required in order to specify whether different combinations of HPV-related biomarkers could enhance the accuracy of follow up, possibly in the form of a Scoring System that could allow tailored post-treatment surveillance.     

Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia

Objective: Previous studies have shown conflicting results on the outcome of pregnancy following loop electrosurgical excision procedure (LEEP). The purpose of this study was to evaluate whether LEEP affects the outcome of pregnancy after 20 weeks gestation. Methods: This is a matched cohort study of all women who had a LEEP for a biopsy-confirmed cervical intraepithelial neoplasia (CIN) in between December 1995 and December 2000 and subsequently delivered (after 20 weeks gestation) at the University Hospital of Northern Norway. Women who had an ectopic pregnancy or an abortion (spontaneous or induced) following LEEP were excluded from analysis. Two controls matched for the date of delivery, age, parity, previous obstetric history and smoking habit were identified for each case using routinely entered data from the birth register. The main outcome measures were the duration of pregnancy and birth weight. Other variables recorded included the grade of cervical dysplasia, size of the electrosurgical loop, age, parity, pregnancy complications, mode of delivery, and perinatal outcome. Results: Of a total of 428 women of reproductive age who had LEEP performed during the study period, 89 had a pregnancy after the procedure. Ten women were excluded (three ectopic pregnancies, two induced abortions and five spontaneous abortions) from the study. Data from 79 women whose pregnancies progressed beyond 20 weeks and 158 matched controls were analysed. The mean age at the time of LEEP was 27 (range 19–36) years. The histological diagnosis was normal in 3 (3.8%), CIN1 in 5 (6.3%), CIN2 in 18 (22.8%), and CIN3 in 53 (67.1%) of the cases. Overall, mean gestation at delivery (38.3 vs. 39.1 weeks), mean birth weight (3,412 vs. 3,563 g), prevalence of preterm birth (11.4% vs. 10.8%) and low birth weight (10.1 vs. 5.1%) were not significantly different among the cases and controls. But when a relatively large loop (25 mm) had been used, the risk of preterm delivery (odds ratio 4.0) and low birth weight (odds ratio 14.0) was significantly higher than in controls. Pregnancy complications occurred more frequently (20 vs. 7%; p=0.006) among the cases than the controls. Conclusion: LEEP in women with CIN did not significantly increase the risk of low birth weight or preterm birth in subsequent pregnancy in comparison to their controls, except when the size of electrosurgical loop was relatively large. However, the prevalence of pregnancy complications was significantly higher after LEEP.     

红色诺卡氏菌细胞壁骨架治疗子宫颈高级别鳞状上皮内病变的安全性和疗效研究

目的 探讨子宫颈外用红色诺卡氏菌细胞壁骨架(Nocardia rubra cell wallskeleton,Nr-CWS)治疗子宫颈高级别鳞状上皮内病变(HSIL)的安全性、耐受性和有效性.方法 选取2017年4月至2018年3月在北京大学第一医院妇产科宫颈中心就诊的子宫颈HSIL患者,回顾性分析子宫颈环形电切除术(...     

宫颈电环切除术后妊娠结局的临床相关研究

目的:探讨宫颈电环切除术对CIN患者术后妊娠结局的影响。方法:收集2000年至2007年因宫颈高度病变行LEEP术、术后成功受孕并已终止妊娠的妇女102例作为病例组。其中,按电切深度分为10～20mm组(76例)和21～25mm组(26例);按电切宽度分为15～20mm组(30例)和21～40mm组(72例)。随机抽取同期门诊无宫颈治疗史的健康孕产妇104例为对照组。追踪并比较各组自然流产率、早产率、胎膜早破率、低出生体重率以及剖宫产率。结果:病例组及对照组分娩孕周均>28周;两组自然流产率、早产率、胎膜早破率、剖宫产率和分娩孕周均无显著差异(P均>0.05);病例组新生儿平均体重显著高于对照组[(3.45±0.29)kg vs(3.32±0.35)kg,P<0.05]。宫颈电切深度为10～20mm组的妊娠结局与21～25mm组无显著差异(P>0.05);宫颈电切宽度为15～20mm组的妊娠结局与21～40mm组亦无显著差异(P>0.05)。结论:宫颈电环切除术对术后妊娠妇女的妊娠结局无明显影响。宫颈电环切除深度<25mm、宽度<40mm时,患者术后妊娠的自然流产、早产、胎膜早破、小于胎龄儿等不良结局发生率无明显增加。     

Loop diathermy excision of the abnormal cervical transformation zone

Abstract. Six-hundred patients with abnormal cervical transformation zones were treated by loop diathermy excision. The patients were referred to the colposcopy clinic in the Regional Department of Gynaecological Oncology, Gateshead with abnormal cervical cytology. The indications for treatment, management and follow-up are presented. All patients were managed as out-patients under local anesthesia (71%) or as half-day inpatients under short general anesthesia (29%). Patients were treated with loop diathermy excision of visible lesions or with loop diathermy conization as required. Eradication of cervical intra-epithelial neoplasia (CIN) was achieved with one treatment in 95.5% of cases of CIN. The procedure is rapidly and easily performed. Major morbidity is rare. Only two patients required blood transfusion following treatment. Loop diathermy excision is ideally suited to a policy of combined diagnosis and treatment for these patients allowing efficient use of clinic time. The danger of inadvertant local destruction of early invasive disease is minimized. When preliminary colposcopically directed punch-biopsy histology was compared to definitive loop histology, CIN3 was detected in 27.4% of loops where the punch biopsies failed to show CIN and one case of CIN3 on punch biopsy was upgraded to invasive squamous carcinoma on loop biopsy. Loop excision biopsy therefore gives more complete histologic information than traditional punch biopsy. This technique is effective, efficient, economical and highly acceptable to both patient and practitioner. It is now the treatment of choice for management of the abnormal transformation zone in our practice.