关键词:

宫颈高级别鳞状上皮内病变, 人乳头瘤状病毒, 宫颈环形电切术, 内切缘, 转化区

Abstract:

Objective　To investigate the relationship of individualizedly designed loop electrosurgical excision procedure with the margin status and prognosis of patients with cervical squamous intraepithelial lesions. Methods　The clinical data of 151 patients with high-grade cervical squamous intraepithelial lesions (HSIL) who took LEEP at Guangdong Women and Children Hospital from January 2015 to December 2019 were retrospectively analyzed. The patients were (35.54±7.29) years old. Sixty cases had fertility requirements, and 91 cases had no fertility requirements. Before the operation, the colposcopists individualizedly designed the LEEP for the patients according to the comprehensive and accurate colposcopic evaluation, cervical cytology, pathology of biopsy, and other factors. The status of the endocervical margin of excised specimens, cervical adhesion, and human papillomavirus (HPV) test results within 2 years after the surgery were statistically analyzed. The multivariate regression analysis was used to analyze the factors influencing the status of the endocervical margin and the relationship of different margin status and surgical procedures with their prognosis. The feasibility and effectiveness of the individualizedly designed LEEP were explored. t, χ², and Fisher's exact probability tests were applied. Results　Among the 151 patients, 131 cases were negative on the margin, and 20 cases positive, with a positive rate of 13.25%. The length and thickness of conization in the patients with fertility requirements were higher than those in the patients with no fertility requirements [(1.18±0.34) cm vs. (0.93±0.21) cm and (1.11±0.45) cm vs. (0.90±0.33) cm]; the proportion of the patients who took LEEP in the patients with fertility requirements was lower than that in the patients with no fertility requirements; there were statistical differences (t=5.680 and 3.459; χ²=6.181; all P<0.05). There was no statistical difference in the margin positive rate between the two groups (P>0.05). The univariate analysis results showed that cervical cytology, the number of quadrants involved in aceto-white epithelium in colposcopy, and lesion grade were correlated with the status of the endocervical margin (all P<0.05). The multivariate logistic regression analysis results showed that the number of quadrants involved in aceto-white epithelium and lesion grade before the surgery and the independent risk factors influencing the endocervical margin after LEEP (both P<0.05). The HPV negative rate within 2 years after the surgery was 82.7%(124/150). There were no statistical differences in cervical stenosis and HPV results 6, 12, and 24 months after the surgery between the patients with different endocervical margin status (all P>0.05). Conclusions　On the premise of patients' fertility requirements, the LEEP designed according to the comprehensive and accurate colposcopic evaluation, cervical cytology, lesion grade, and other factors is clinically feasible and effective, especially for the women with fertility requirements.

Key words:

High-grade squamous intraepithelial lesion, Human papillomavirus, Loop electrosurgical excision procedure, Endocervical margin,  , Transformation zone