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

摘要：

目的　本研究旨在探讨个体化宫颈锥切手术设计与切缘状况及宫颈病变预后之间的关系。方法　收集2015年1月至2019年12月在广东省妇幼保健院门诊因宫颈高级别鳞状上皮内病变（HSIL）行宫颈环形电切术（LEEP）的151例患者进行回顾性研究，年龄（35.54±7.29）岁，其中有生育要求60例、无生育要求91例。术前阴道镜医师在全面、准确阴道镜评估基础上结合宫颈细胞学、宫颈活检病理等因素对患者分别进行个体化LEEP手术设计，收集术后标本内切缘状况、宫颈口粘连狭窄及2年内复查人乳头瘤病毒（HPV）检测结果。多因素logistic回归分析影响LEEP手术标本内切缘状况的相关因素，以及不同切缘状况、手术方式与疾病预后之间的关系，探讨个体化LEEP手术设计的可行性和有效性。统计学方法采用t检验、χ²检验、Fisher确切概率法检验。结果　151例行LEEP手术患者内切缘阳性20例，内切缘阴性131例，切缘阳性率为13.25%。无生育要求患者锥切长度、锥切厚度均大于有生育要求患者［（1.18±0.34）cm比（0.93±0.21）cm、（1.11±0.45）cm比（0.90±0.33）cm］，且“一刀切”的LEEP手术占比低于有生育要求患者［75.8%（69/91）比91.7%（55/60）］，差异均有统计学意义（t=5.680、3.459，χ²=6.181；均P<0.05）；两组内切缘阳性率比较，差异无统计学意义（P>0.05）。单因素分析结果显示，术前宫颈细胞学、阴道镜下醋白上皮累及象限数、术前活检病变级别与LEEP手术标本内切缘状况具有相关性（均P<0.05）。多因素logistics回归分析结果显示，阴道镜下醋白上皮累及象限数、术前活检病变级别是影响LEEP术后标本内切缘的独立危险因子（均P<0.05）。术后随访2年HPV总转阴率为82.7%（124/150）。不同内切缘状况患者随访数据表明，术后宫颈口狭窄及术后6个月、12个月、24个月HPV检测结果比较，差异均无统计学意义（均P>0.05）。结论　以患者生育要求为前提，在全面准确阴道镜评估基础上结合患者宫颈细胞学及病变级别等因素进行个体化的锥切手术设计，临床上是可行且有效的，尤其是对有生育要求的女性更具临床价值。

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