發(fā)布時間：2018-08-10 19:50

【摘要】：目的：1.分析高級別宮頸上皮內(nèi)瘤變（CINII、CINIII）隨訪對象的臨床特點；評價宮頸環(huán)形電切術(shù)(LEEP)治療高級別CIN的有效性與安全性；2.探討TCT及HPV檢測在隨訪過程中的價值；殘留、復發(fā)的高危因素；手術(shù)對妊娠結(jié)局的影響。 方法：1.選擇2008年1月至2010年12月在皖南醫(yī)學院第一附屬醫(yī)院婦產(chǎn)科陰道鏡門診接受LEEP保守治療并病理診斷為CINII、CINIII持續(xù)有定期隨訪記錄的患者共321例進行平均為期52.2月的定期隨訪。2.定期行薄層液基細胞學(TCT）和（或）人乳頭瘤病毒(HPV)分型檢測，當TCT診斷為ASCUS及其以上結(jié)果、持續(xù)性HPV感染或患者有可疑主訴均進行陰道鏡檢查，以病理結(jié)果為最終診斷。3.利用SPSS16.0對收集到的數(shù)據(jù)進行描述性分析；率的比較采用χ2檢驗；Logistic回歸分析宮頸上皮內(nèi)瘤變LEEP后殘留、復發(fā)高危險因素；以α＜0.05為檢驗標準。 結(jié)果：1：隨訪5年內(nèi)發(fā)現(xiàn)術(shù)后3月殘留1例，復發(fā)11例，盆腔淋巴結(jié)轉(zhuǎn)移性鱗狀細胞癌1例；309例5年內(nèi)未發(fā)現(xiàn)病變，治愈率為96.26%，失敗率為3.74%。2：TCT陽性患者17例，共計25次；其中HSIL2例，均證實復發(fā)（2/2）、LSIL(5/9)、ASC-H(1/4)、ASCUS(4/10),其陽性預測值分別為100%、55.56%、25.00%、40.00%。3：241例（受檢率75.1%）患者術(shù)后接受HPV分型檢測；HPV感染的有80例（1-5次），共計131次,HPV16、58、52、18陽性患者各23例、16例、14例、7例，對上述4種型別的感染通過聯(lián)合TCT檢查、定期復查或陰道鏡檢查誤診率為：5.6%、6.25%、14.29%、0%。對LEEP后HPV感染率的比較采用卡方檢驗，p值=0.01，即LEEP后隨訪人群隨著時間的延長HPV感染率下降趨勢有統(tǒng)計學意義。LEEP前HPV感染患者術(shù)后HPV清除率的比較采用卡方檢驗，p值0.01，即LEEP對感染人群的HPV清除效果明顯。4：TCT檢查、HPV分型檢測以及兩者聯(lián)合檢測的敏感性、特異性、陽性預測值、陰性預測值分別為：68.75%、99.27%、44.00%、99.73；92.00%、90.43%、17.16%、99.81%；90.00%、99.81%、81.81%、99.90%。5：采用Logistic回歸分析示：絕經(jīng)（p=0.001）、切緣陽性(p=0.035)、HPV感染（p=0.006）是LEEP后CINII、CINIII復發(fā)的危險因素;年齡（p=0.639）、病理分級（p=0.262）、累及腺體（p=0.496）與術(shù)后復發(fā)無統(tǒng)計學關(guān)系，不是其復發(fā)高危因素。6：隨訪五年內(nèi),術(shù)后有生育愿望的16例患者中15例均自然受孕，受孕率為93.75%，除1例孕36+4周早產(chǎn)，1例孕4月定期產(chǎn)檢中，余均足月剖宮產(chǎn)分娩。妊娠41例計51次（1-3次），24例因非意愿懷孕行人工流產(chǎn)術(shù)29次（1-2次）；有生育史患者18例計19次（1-2次）；胎膜早破及早產(chǎn)率均為10.53%（2/19），擇期剖宮產(chǎn)分娩。 結(jié)論：1.LEEP治療宮頸上皮內(nèi)高度病變具有有效性與安全性。2.TCT聯(lián)合HPV檢測陽性、陰性預測值高，是術(shù)后隨訪的可靠方法。3.術(shù)后隨訪方案應根據(jù)每位病人的切緣情況、術(shù)后HPV檢測情況、絕經(jīng)狀況及綜合因素評估，加強高危病人的檢測，制定個體化檢查方案。4.LEEP對患者的受孕率、妊娠結(jié)局無明顯影響。
[Abstract]:Objective: 1. To analyze the clinical characteristics of high-grade cervical intraepithelial neoplasia (CINII, CINIII) patients, evaluate the efficacy and safety of LEEP in the treatment of high-grade CIN, 2. To explore the value of TCT and HPV detection in the follow-up process, residual, high-risk factors of recurrence, and the impact of surgery on pregnancy outcome.
Methods: 1. From January 2008 to December 2010, 321 conservative LEEP patients with CINII and CINIII patients with CINII were selected from the vaginoscopy clinic of the First Affiliated Hospital of Southern Anhui Medical College. The average follow-up period was 52.2 months. Colposcopy was performed when TCT was diagnosed as ASCUS or above, persistent HPV infection or suspicious complaints were confirmed by pathology. 3. SPSS16.0 was used to analyze the collected data descriptively; _2 test was used to compare the rates; logistic regression was used to analyze LEEP of cervical intraepithelial neoplasia. Residual risk of recurrence was high, and alpha < 0.05 was the test standard.
Results: 1: Follow-up within 5 years found 1 residual case, recurrence in 11 cases, pelvic lymph node metastatic squamous cell carcinoma in 1 case; 309 cases within 5 years did not find lesions, the cure rate was 96.26%, the failure rate was 3.74%. 2: TCT positive patients 17 cases, a total of 25 times; HSIL 2 cases, confirmed recurrence (2/2), LSIL (5/9), ASC-H (1/4), ASCUS (4/10), the positive pre-diagnosis. 3:241 (75.1%) patients received HPV typing test after operation; 80 (1-5) patients with HPV infection, a total of 131 times, 23 HPV 16, 58, 52, 18 positive patients, 16 cases, 14 cases, 7 cases of the above four types of infection through combined TCT examination, regular review or colposcopy misdiagnosis rate: 5.6%, 6.6%. Chi-square test was used to compare the HPV infection rate after LEEP, P = 0.01, that is, the HPV infection rate of the follow-up group after LEEP decreased with the extension of time has statistical significance. The sensitivity, specificity, positive predictive value and negative predictive value of PV typing and combined detection were 68.75%, 99.27%, 44.00%, 99.73, 92.00%, 90.43%, 17.16%, 99.81%, 90.00%, 99.81%, 81.90% respectively. 5: Logistic regression analysis showed that menopause (p = 0.001), margin positive (p = 0.035), HPV infection (p = 0.006) was CINII after LEEP, CINII. CINIII recurrence risk factors; age (p = 0.639), pathological grade (p = 0.262), gland involvement (p = 0.496) and postoperative recurrence were not statistically related, is not a high risk factor for recurrence. Pregnancies were 51 times (1-3 times), artificial abortion 29 times (1-2 times) for unwanted pregnancy in 24 cases, 19 times (1-2 times) for 18 cases with childbearing history, premature rupture of membranes and premature delivery rate were 10.53% (2/19), selective cesarean section.
Conclusion: 1. LEEP is effective and safe in the treatment of high-grade cervical intraepithelial lesions. 2. TCT combined with HPV detection is positive, negative predictive value is high, is a reliable method for postoperative follow-up. 3. Follow-up program should be based on each patient's incision margin, postoperative HPV detection, menopausal status and comprehensive factors evaluation, strengthen the detection of high-risk patients. The individualized examination plan.4.LEEP had no significant effect on the pregnancy rate and pregnancy outcome of the patients.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.33

【參考文獻】

相關(guān)期刊論文 前10條

1 程嬌影;卞美璐;馬莉;劉軍;陳穎;;HPV感染年齡與高度宮頸上皮內(nèi)瘤變的關(guān)系[J];中國婦產(chǎn)科臨床雜志;2011年02期

2 吳瑾;賈英;唐良萏;;LEEP術(shù)后宮頸上皮內(nèi)瘤變復發(fā)病因分析[J];激光雜志;2012年02期

3 王歡華;陳麗;黃玲;吳利玲;陳梅;黃湘源;;重型宮頸上皮內(nèi)瘤變LEEP術(shù)后殘留和復發(fā)的隨訪[J];臨床腫瘤學雜志;2010年06期

4 王浩;李自康;賈勛超;;原發(fā)部位不明的轉(zhuǎn)移癌12例分析[J];中國全科醫(yī)學;2007年23期

5 申艷;;宮頸上皮內(nèi)瘤變LEEP術(shù)后檢測HPV評價療效的臨床應用探討[J];實用婦產(chǎn)科雜志;2007年08期

6 周斌;左新華;傅新文;;高危型人乳頭狀瘤病毒16,18型DNA檢測在宮頸病變篩查中的應用價值[J];檢驗醫(yī)學;2012年05期

7 董穎;;TCT聯(lián)合高危型HPV基因檢測在絕經(jīng)后婦女宮頸上皮內(nèi)瘤變篩查的價值評估[J];生殖與避孕;2012年06期

8 陶承靜;文彩荷;何蓮芝;;蕪湖地區(qū)823名婦女宮頸HPV感染狀況的調(diào)查分析[J];中國現(xiàn)代醫(yī)生;2011年17期

9 韓歷麗;齊慶青;王朝;張月;董翠英;王連英;丁輝;;北京市宮頸癌篩查宮頸細胞學結(jié)果分析[J];中國婦幼保健;2011年13期

10 馮靜;王朝華;王建六;魏麗惠;;宮頸冷刀錐切治療宮頸上皮內(nèi)瘤樣病變Ⅲ級的評價[J];中國實用婦科與產(chǎn)科雜志;2006年10期

，

本文編號：2176023