本文選題：HSIL　切入點(diǎn)：LEEP術(shù)　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析行宮頸環(huán)形電切術(shù)(Loop electrosurgical excision procedure,LEEP)后高級(jí)別宮頸上皮內(nèi)瘤變(HSIL)患者病灶殘余的相關(guān)危險(xiǎn)因素及其臨床轉(zhuǎn)歸情況,評(píng)估病灶殘余的高危因素,為臨床工作提供依據(jù)。研究對(duì)象和方法:回顧性分析2013年1月-2016年10月就診于山西醫(yī)科大學(xué)第一醫(yī)院婦科的初次行LEEP術(shù)并行二次全子宮切除的131例HSIL患者的LEEP手術(shù)資料、子宮全切住院病歷、術(shù)后3月、6月、12月門診隨訪資料,分析內(nèi)容包括:一般信息:患者年齡(Age)、絕經(jīng)狀態(tài)(Menopausal status)、孕次(Gravidity)、產(chǎn)次(Parity)、術(shù)前TCT檢測(cè)、術(shù)前HC2 HPV DNA、HPV(Human papillomavirus)感染亞型、VAIN;LEEP術(shù)相關(guān)信息:宮頸上皮腺體是否累及、初次LEEP術(shù)錐高及錐寬、宮頸病變級(jí)別、切緣與病灶的距離;陰道鏡檢滿意否;子宮全切相關(guān)信息:出血量、全宮切手術(shù)方式、術(shù)后標(biāo)本病理信息等;術(shù)后隨訪TCT檢測(cè)、HC2 HPV DNA。(1)根據(jù)二次全宮切術(shù)后病理中是否仍存在HSIL將131例患者分為有病灶殘余組和無(wú)病灶殘余組。對(duì)病灶殘余可能的相關(guān)危險(xiǎn)因素進(jìn)行篩選,繼而行回歸分析。(2)根據(jù)錐切標(biāo)本切緣與病變距離對(duì)切緣陽(yáng)性進(jìn)行分組,探討其與病灶殘余的關(guān)系;(3)子宮全切術(shù)后的高危型HPV的轉(zhuǎn)歸。結(jié)果:1、進(jìn)入研究的患者有131例,年齡范圍為(33-67)歲,平均(51.22±7.78)歲,手術(shù)方式:開(kāi)腹/腹腔鏡構(gòu)成比例51:80,病灶殘余者共52例,殘余率為39.70%。2、單因素分析結(jié)果提示:病變累及宮頸上皮腺體(OR=2.31,P0.05)、術(shù)前HC2HPV DNA負(fù)荷量檢測(cè)300RLU/CO(OR=2.13,P0.05);而與患者年齡、絕經(jīng)狀態(tài)、孕產(chǎn)次、術(shù)前宮頸薄層液基細(xì)胞檢測(cè)、HPV感染亞型、宮頸病變級(jí)別、LEEP錐切的高度和寬度、二次手術(shù)與LEEP術(shù)平均間隔時(shí)間、全宮切平均所用時(shí)間、全宮切平均出血量、全宮切手術(shù)方式等無(wú)關(guān)。3、多因素邏輯回歸分析(Logistic regression analysis)結(jié)果提示:HC2 HPV DNA負(fù)荷量為L(zhǎng)EEP術(shù)后病灶殘余的高度危險(xiǎn)因子。4、根據(jù)錐切標(biāo)本切緣與病變距離對(duì)切緣陽(yáng)性分為四組(3mm,1-3mm,1mm,切緣可見(jiàn)病變),病灶殘余率分別為11.11%(1/9)、11.76%(2/17)、12.90%(8/62)及95.35%(41/43),4組之間的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。5、子宮全切術(shù)后HR HPV的轉(zhuǎn)歸:對(duì)于術(shù)前HR HPV提示高負(fù)荷者,全宮切術(shù)后定期隨訪12個(gè)月后有124例(94.66%)HR HPV負(fù)荷量完全轉(zhuǎn)陰。結(jié)論:1、術(shù)前HC2 HPV DNA負(fù)荷量檢測(cè)300RLU/CO為L(zhǎng)EEP術(shù)后病灶殘余的高危因素,因此在進(jìn)行HSIL患者診治時(shí)應(yīng)對(duì)有高危因素的案例應(yīng)加以注重,以防病灶殘余。2、如果在行宮頸錐切術(shù)后切緣提示陽(yáng)性,則切緣距離病變愈近,愈有必要考慮二次手術(shù)。3、對(duì)LEEP術(shù)后切緣陽(yáng)性且HR HPV高負(fù)荷者行全子宮切除術(shù)是有意義的。
[Abstract]:Objective: to analyze the risk factors and clinical outcome of the patients with high grade cervical intraepithelial neoplasia (HSILs) after loop electrosurgical excision procedure, and to evaluate the risk factors of residual lesions. Methods: from January 2013 to October 2016, we retrospectively analyzed the LEEP operation data of 131 HSIL patients who underwent LEEP and secondary hysterectomy in gynecology department of the first Hospital of Shanxi Medical University from January 2013 to October 2016. The medical records of total hysterectomy were followed up on March, June and December. The contents of analysis included: age of patients, Menopausal statusus, gravidity of pregnancy, parity of labor, TCT detection before operation. Preoperative HC2 HPV DNA-HPV-Human papillomavirus-related information: involvement of cervical epithelial glands, height and width of initial LEEP cones, grade of cervical lesions, distance between incisal margin and lesion; satisfactory vaginal examination; information related to total hysterectomy: bleeding volume, Methods of total hysterectomy, pathological information of postoperative specimens, etc. TCT was followed up to detect HC2 HPV DNA. 1) according to the presence of HSIL in the pathology after secondary hysterectomy, 131 patients were divided into two groups: the group with or without residual lesions. The possible risk factors of residual lesions were screened. Then regression analysis was carried out. (2) according to the distance between the incised margin and the lesion of the conical specimen, the positive rate of the incisal margin was divided into two groups, and the relationship between the positive margin and the residual lesion was discussed. The outcome of high-risk HPV after total hysterectomy was analyzed. Results: one hundred and thirty-one patients entered the study. The age range was 33-67 years (mean 51.22 鹵7.78) years. The operative method: the ratio of laparotomy to laparoscopy was 51: 80. 52 cases had residual lesions. The residual rate was 39.70. 2. The results of univariate analysis showed that the lesion involved the cervix epithelium OR2.31 and the preoperation HC2HPV DNA load was measured by 300RLU / Cochor 2.13 P0.05, but with age, menopausal status, pregnant and parturition, the cervical epithelium was detected for the subtype of HPV-infected by fluid base cells before operation. The height and width of LEEP conical resection, the average interval between secondary surgery and LEEP, the average time of hysterectomy, the mean bleeding amount of total hysterectomy, the degree of cervical lesions, the average time between the second operation and the LEEP procedure, and the mean time taken during the resection of the cervix. The results of multivariate logistic regression analysis showed that the DNA load of HPV / HC2 was a high risk factor of residual lesion after LEEP. According to the incised margin of conical specimen and the distance between the lesion and the cut edge of the specimen, the positive rate of the lesion was divided into four groups. The residual rate of lesion was 11.11 / 9 / 11.76 / 2 / 12.90 / 62) and 95.3535 / 41 / 43 respectively. There was significant difference between the four groups (P < 0.05.5. 5). The outcome of HR HPV after total hysterectomy: it was suggested that HR HPV had high load before and after hysterectomy. After regular follow-up 12 months after hysterectomy, 124 cases of HR HPV load completely turned negative. Conclusion HC2 HPV DNA load of 300RLU / CO is the high risk factor for residual lesions after LEEP operation. Therefore, in the diagnosis and treatment of HSIL patients, we should pay attention to the cases with high risk factors, so as to prevent residual. 2. If positive cutoff after cervical conization, the cutting edge is closer to the lesion. It is necessary to consider the second operation. 3. It is significant for the patients with positive margin after LEEP and high load of HR HPV to perform total hysterectomy.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

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