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目的:探讨宫颈上皮内瘤变2~3级(cervical intraepithelial neoplasia,CIN)的临床指标与宫颈环状电切术(loop electrosurgical excision procedure,LEEP)治疗预后的相关性。方法:回顾性分析835例CIN2~3级患者行LEEP术前的细胞学检查(Thin Prep cell test,TCT),人乳头状瘤病毒(human papillomavirus,HPV)及病检,与术后切缘及复发的关系。结果:术后切缘阳性者105例(12.6%),CIN3及CIN累腺组切缘阳性率高(P<0.05);复发者19例(2.3%),HPV16型组复发率高(P<0.05);多因素logistic分析中,术前CIN3组(OR=1.717,95%CI=1.110~2.656)和腺体受累组(OR=1.611,95%CI=1.048~2.477)术后切缘阳性的风险增高;术前HPV16阳性(OR=5.840,95%CI=1.772~19.275)术后CIN复发风险增高,但切除宽度>2 cm组(OR=0.240,95%CI=0.065~0.888)复发的风险降低。结论:术前CIN3及CIN累及腺体可作为LEEP切除范围的指导指标,而HPV16感染可作为预测术后复发的指标。
Objective: To investigate the relationship between the clinical features of cervical intraepithelial neoplasia (CIN) and prognosis of cervical loop electrosurgical excision procedure (LEEP). Methods: A retrospective analysis of 835 cases of CIN2 ~ 3 patients undergoing LEEP preoperative cytological examination (Thin Prep cell test, TCT), human papillomavirus (HPV) and pathological examination, and postoperative margins and Relapse relationship. Results: The positive rate of positive margins in CIN3 and CIN glands was significantly higher in 105 cases (12.6%) than in those with positive margins (P <0.05), recurrence in 19 cases (2.3%) and high recurrence rate in HPV16 group (P < 0.05). In the multivariate logistic analysis, there were positive margins in the preoperative CIN3 group (OR = 1.717, 95% CI = 1.110-2.656) and glandular involvement group (OR = 1.611, 95% CI = 1.048-2.477) (OR = 5.840, 95% CI = 1.772-19.275), the risk of recurrent CIN was higher in patients with resection width> 2 cm (OR = 0.240, 95% CI = 0.065-0.888) reduce. Conclusions: Preoperative CIN3 and CIN involvement of glands can be used as a guideline for LEEP resection range, while HPV16 infection can be used as an index to predict postoperative recurrence.