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目的探讨应用高危型人乳头瘤病毒(HR-HPV)载量指导宫颈轻度鳞状上皮内瘤变(CINⅠ)的治疗及随访方法。方法 CINⅠ并人乳头瘤病毒(HPV)感染的患者160例,按治疗方法分为三组,切除组(60例)应用转化区大环状切除术(LLETZ)切除宫颈移行带,破坏组(60例)应用微波或电灼对宫颈病变表面进行破坏治疗,对照组(40例)给予观察,不采取干预措施。结果治疗6个月后,切除组HPV转阴率明显高于破坏组和对照组(P<0.05)。治疗12个月后,切除组几乎全部转阴(96.7%),破坏组转阴率(73.3%)明显高于对照组(35.0%)(P<0.05)。由此可见,切除治疗对CINⅠ患者的HPV清除效果最好,其次为破坏治疗,最后为观察治疗。各组间高、中、低负荷HPV的患者比例差异无统计学意义(P>0.05)。治疗1年后,对照组中,高负荷患者无一例转阴,低负荷患者转阴率(53.3%)与中负荷患者(50.0%)类似(P>0.05);破坏组中,中负荷患者转阴率(70.0%)比高负荷患者(52.6%)高,低负荷患者转阴率(95.2%)高于中、高负荷患者(P<0.05);切除组中,HPV几乎全部转阴,与载量关系不大。切除治疗在HPV高、中、低负荷各组的治疗效果是最好的,但是破坏治疗和观察治疗在中、低负荷HPV患者中的转阴率均超过50.0%,在不能接受切除治疗的人群中不失为一种较好的治疗方案。结论对于病理诊断为CINⅠ的患者,HPV载量100~、已生育、出血症状明显者可考虑行LLETZ治疗,而载量1~99.99可考虑行破坏或观察治疗,但对于没有生育要求、随访困难及HPV持续阳性(超过1年)者则需考虑改变治疗方案。
Objective To investigate the treatment and follow-up of cervical intraepithelial neoplasia (CIN Ⅰ) guided by high-risk human papillomavirus (HR-HPV). Methods 160 patients with CIN Ⅰ and HPV infection were divided into three groups according to the treatment method. The patients in the resection group (60 cases) were treated with LLETZ, Cases) Microwave or electrocautery treatment of cervical lesions on the surface of the destruction treatment, the control group (40 cases) were given an observation without intervention. Results After 6 months of treatment, the negative rate of HPV in the resection group was significantly higher than that in the destruction group and the control group (P <0.05). After 12 months of treatment, almost all of the patients in the resection group became negative (96.7%), while the rate of rejection in the damaged group (73.3%) was significantly higher than that of the control group (35.0%) (P <0.05). Thus, removal of CIN Ⅰ patients with HPV removal of the best, followed by the destruction of treatment, the last observation and treatment. There was no significant difference in the proportion of high, medium and low-load HPV among the groups (P> 0.05). One year after the treatment, none of the patients in the control group had a negative conversion. The negative conversion rate (53.3%) in the low-load group was similar to that in the medium-load group (50.0%) (P> 0.05) The negative rate (70.0%) was higher than that of the patients with high load (52.6%). The rate of negative conversion (95.2%) in patients with low load was higher than that in medium and high load patients (P <0.05) Little relationship between the load. Excision therapy is the best in each group of high, medium and low-load HPV, but the rate of negative conversion in the treatment of failure and observation is more than 50.0% in medium and low-load HPV patients, and in those who can not be treated by resection In a good way to treat. Conclusions For patients with pathologically diagnosed CIN I, LLETZ treatment may be considered with a 100% load of HPV, fertility and bleeding. However, patients with a load of 1 to 99.99 can be considered for treatment of destruction or observation. However, for those with no fertility requirements, follow-up difficulties And persistent HPV (more than 1 year) who need to consider changing the treatment plan.