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目的探讨宫颈环形电切术(LEEP)的诊断价值及宫颈上皮内瘤变Ⅲ(CINⅢ)和宫颈鳞癌Ia1期术后病变残留的危险因素。方法 CINⅢ和Ia1期宫颈鳞癌患者52例,回顾性分析阴道镜下活检、LEEP及子宫切除CIN病理结果,探讨宫颈环切切缘、LEEP术前高危型人乳头状病毒(HR-HPV)载量与病变残留的关系。结果切缘阴性者病变残留率为34.6%,切缘阳性者为57.7%(P>0.05)。无病变残留者LEEP术前HR-HPV载量中位数为28.82,明显低于有病变残留者的640.97(P<0.05)。ROC曲线发现当切缘阴性且HR-HPV≤64.11时,病变残留的阴性预测值为100.0%;当切缘阳性且HPV≥17.59时,病变残留的阳性预测值为66.7%。结论 CIN及Ia1具有多病灶共存的特性,LEEP可避免遗漏严重病变;合理应用术前HR-HPV病毒载量结合切缘状态,可为临床处理提供依据。
Objective To investigate the diagnostic value of cervical ring electrosurgical excision (LEEP) and the risk factors of postoperative lesions in cervical intraepithelial neoplasia Ⅲ (CINⅢ) and cervical squamous cell carcinoma (IaI). Methods Fifty-two patients with cervical squamous cell carcinoma of CINⅢ and Ia1 were retrospectively analyzed. Results of biopsy, LEEP and Cystectomy of hysterectomy were analyzed retrospectively. The margins of cervical ring incision, the high-risk human papillomavirus (HR-HPV) Relationship with residual disease. Results The negative rate of residual disease was 34.6%, positive margin was 57.7% (P> 0.05). The median HR-HPV load of LEEP without residual disease was 28.82, which was significantly lower than 640.97 (P <0.05) of those with residual disease. The ROC curve showed that the negative predictive value of residual lesions was 100.0% when the negative margins were HR-HPV≤64.11, and the positive predictive value of residual lesions was 66.7% when the positive margins and HPV≥17.59. Conclusions CIN and Ia1 have the characteristics of multi-lesion coexistence. LEEP can avoid the omission of serious pathological changes. The reasonable application of preoperative HR-HPV viral load combined with the status of the margins can provide the basis for clinical treatment.