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[目的]分析子宫颈环型电切术(LEEP)治疗子宫颈上皮内瘤变(CIN)的疗效及其影响因素、术后随访时机,为LEEP规范化治疗CIN提供科学依据。[方法]选择2009年6月至2010年12月在深圳市妇幼保健院因CIN行LEEP治疗病例1535例作为研究对象,并在术后随访2年,观察LEEP治疗效果。[结果]1535例患者中排除确诊为浸润癌的13例患者,随访2年时间共1297例,随访率为85.2%(1297/1522),其中持续存在或复发35例(含浸润癌1例),病变持续存在或复发率2.7%;治愈1262例,治愈率97.3%。术后切缘阳性组病变持续存在或复发率明显高于阴性组(P<0.01)。术前HPV16/18亚型感染患者LEEP治疗失败风险是其他亚型感染患者的3.383倍。术后第6个月HR-HPV载量≥1.0×105copies/ml的患者病变持续存在或复发率明显高于<1.0×105copies/ml者(OR=23.851,P<0.01)。术后第6个月HR-HPV阳性率和细胞学检查阳性率明显下降,较术后第3个月明显降低(P<0.05),与术后6个月后的HR-HPV阳性率和细胞学检查阳性率无统计学差异(P>0.05)。[结论 ]LEEP治疗CIN的治愈率较高,并发症的发生率相对较低;切缘阳性、HPV16/18亚型感染、术后第6个月HR-HPV载量≥1.0×105copies/ml是本组研究对象LEEP治疗后子宫颈上皮内瘤变持续存在或复发的影响因素;LEEP治疗后6个月是评价疗效的起始时间。
[Objective] To analyze the curative effect and influencing factors of cervical intraepithelial neoplasia (LEEP) on cervical intraepithelial neoplasia (CIN) and the timing of postoperative follow-up, so as to provide a scientific basis for the standardized treatment of CIN by LEEP. [Methods] From June 2009 to December 2010, 1535 cases of LEEP treated by CIN in Shenzhen Maternal and Child Health Care Hospital were selected as research objects and were followed up for 2 years to observe the therapeutic effect of LEEP. [Results] Among the 1535 patients, 13 patients were excluded from the diagnosis of invasive carcinoma. A total of 1297 patients were followed up for 2 years with a follow-up rate of 85.2% (1297/1522). Of the 1535 patients, 35 were persistent or recurrent (1 with invasive carcinoma) , The disease persisted or the recurrence rate was 2.7%; cured 1262 cases, the cure rate was 97.3%. The positive rate of recurrence in the positive margin group was significantly higher than that in the negative group (P <0.01). Preoperative HPV16 / 18 subtype infection LEEP treatment failure risk 3.383 times those of other subtypes. Patients with HR-HPV load ≥1.0 × 105copies / ml at 6 months after operation had persistent or recurrence rates significantly higher than 1.0 × 105copies / ml (OR = 23.851, P <0.01). The positive rate of HR-HPV and the positive rate of cytology at the 6th month after operation were significantly lower than those at the 3rd month after operation (P <0.05), and the positive rate of HR-HPV after 6 months and cells There was no significant difference in the positive rate of the test (P> 0.05). [Conclusion] The cure rate of LEIN in CIN is relatively high, and the complication rate is relatively low. Positive margins and HPV16 / 18 subtype infection, the HR-HPV load≥1.0 × 105copies / ml at 6th month The subjects of LEEP treatment of cervical intraepithelial neoplasia persist or recurrence of factors; 6 months after the LEEP treatment is to evaluate the efficacy of the start time.