高度宫颈上皮内瘤变电环切术后复发的预测因素

目的探讨高度宫颈上皮内瘤变经环形电切术（LEEP）后病情复发的危险因素及其在随访过程中的检测手段。方法通过回顾性分析我院2008-2010年经LEEP手术治疗且通过病理切片证实为CINⅡ或CINⅢ的250位患者术前高危型HPV DNA以及液基细胞学（TCT）情况,术后24个月,利用高危型HPV DNA基因型预测、P16inkta过表达检测、术前术后相同HR-HPV基因型预测等手段进行随访调查,根据所得结果并结合临床病理学特点,分析TCT、HPV DNA与高度宫颈上皮内瘤变复发的关系,并探讨高危HPV检测,P16inkta过表达及TCT检测作为随访检查手段的效果。结果 250例患者在经过24个月的随访检查后发现有25例复发,复发率为10%。手术病理切缘结果、宫颈管搔刮术结果、手术后TCT结果、手术后HR-HPV结果、P16inkta检测结果在复发组与未复发组比较差异有统计学意义（P〈0.01）;基因同型与不同型者复发率分别为85%、12%,两者比较差异有统计学意义（P〈0.01）;术后随访时,手术前后HPV基因型别是否相同和手术后HR-HPV检查敏感度最高,而P16inkta检测的特异性最好。结论宫颈管搔刮阳性和手术病理切缘阳性是LEEP术后复发的重要危险因素,术后随访采用术前术后相同HR-HPV基因型预测以及P16inkta过表达检测、HPV DNA预测复发结合TCT检查十分重要,可以有效地提高手术后复发预测的准确率。

Predictive factors for recurrence of high-grade cervical intraepithelial neoplasia after LEEP.

Objective To investigate the risk factors for recurrence of high-grade cervical intraepithelial neo- plasia after LEEP and the detection methods in the follow-up process. Methods A group of 250 preoperative patients in our hospital from 2008 to 2010 after LEEP who was confirmed CIN ]I and CIN II by pathology were analyzed ret- rospectively for HPV DNA and TCT. 24 months after LEEP, high risk HPV DNA gene prediction, P16inkta overex- pression detection, and the same HR-HPV genotyping prediction were used for the follow-up examination. The corre- lation between TCT, HPV DNA and the recurrence of high-grade cervical intraepithelial neoplasia was investigated, and the effect of high risk HPV DNA gene prediction, P 16inkta overexpression, and TCT as methods for follow-up ex- amination. Results After 24 months of follow-up, in all of the 250 patients, there were 25 cases of recurrence, with the recurrence rate of 10%. The difference of the cutting edge surgical pathology, endocervical curettage, TCT results and post-operative HR-HPV, P16inkta test results between the recurrence group and non-recurrence group was statisti- cally significant （P〈0.01）. The recurrence rates for genes of the same type and different type were 85%, 12%, respec- tively, with statistically significant difference （P〈0.01）. In postoperative follow-up, the HPV genotypes before and af- ter surgery and post-operative HR-HPV checking had the highest sensitivity, and Pl6inkta showed the highest specific- ity of detection. Conclusion Cervical canal curettage positive and operation pathology positive margin are important risk factors of recurrent LEEP after operation. Postoperative follow-up with same HR-HPV genotyping prediction, P16inkta overexpression detection, HPV DNA gene prediction combined with TCT examination are very important, which can effectively improve the accuracy rate of recurrence prediction after operation.