高级别宫颈鳞状上皮内病变LEEP术后病理升降级的相关因素分析

目的 探讨宫颈高级别鳞状上皮内病变(HSIL)宫颈环形电切术(LEEP)患者术后病理升降级的相关因素.方法 回顾性分析2019年1月至2020年6月在上海交通大学附属国际和平妇幼保健院就诊的经阴道镜活检组织学诊断为HSIL并接受LEEP手术的449例患者的临床资料,比较各相关因素与术后病理升降级的关系.结果 ①年龄＜4...

Analysis of the related factors of pathological upgrading and degradation of high-grade squamous intraepithelial lesions after LEEP

Objective?To investigate the related factors of pathological changes after loop electrosurgical excision procedure (LEEP) in patients with high-grade squamous intraepithelial lesion (HSIL). Methods?The clinical data of 449 patients with HSIL diagnosed by cervical biopsy under colposcopy and treated by LEEP in the International Peace Maternal and Child Health Hospital Affiliated to Shanghai Jiaotong University from January 2019 to June 2020 were retrospectively analyzed.The relationship between the related factors and postoperative pathology was compared. Results?① The rate of pathological degradation was 24.5% (63/257) and 16.1% (31/192) ,the upgrade rate was 5.8% (15/257) and 15.1% (29/192) at age <40 years and ≥40 years, respectively, the differences between the two groups were statistically significant (P<0.05).② There was statistical difference between hPV16/18 positive group and HPV16/18 negative group (P<0.01).③ About the TCT results, 14 cases (5.3%), 166 cases (63.1%) and 83 cases (31.6%) of NILM/ASC-US/LSIL group had pathological upgrade, coincidence and degradation, respectively. There were 30 cases (16.1%), 145 cases (78.0%) and 11 cases (5.9%) in HSIL/ASC-H/AGC group, respectively, and the difference was statistically significant (P<0.01).④ In colposcopy images, there were statistically significant differences according to the maximum diameter line of lesions, lesion location, SCJ visibility and atypical vessels (P<0.05).⑤ The maximum diameter of the lesion, the location of the lesion, the presence or absence of atypical vessels and the visibility of SCJ under colposcopy, were the independent influencing factors for predicting the postoperative pathological upgrading (P<0.05); TCT results, HPV16/18 infection and lesion location were independent influencing factors for predicting postoperative pathological downgrading(P<0.05). Conclusions?Comprehensive evaluation of colposcopic images, TCT and HPV results before LEEP is of great significance for the selection of treatment options.