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目的探讨宫颈环形电切术(LEEP)治疗宫颈鳞癌Ⅰa 1期的可行性和安全性。方法行宫颈LEEP术后病理诊断为宫颈鳞癌Ⅰa 1期患者78例,接受经阴道根治性宫颈切除或全子宫切除术,结合其临床病理特征,分析LEEP术后病灶残留相关因素。结果 78例患者中,36例行经阴道根治性宫颈切除,42例行全子宫切除术。术后病理结果提示有病灶残留11例,残留率14.10%。其中,宫颈鳞状上皮不典型增生(CIN)Ⅱ级2例,CINⅢ级6例,早期癌3例。切缘阳性组患者病灶残留率22.86%(8/35),高于切缘阴性组的6.98%(3/43)(P<0.05)。年龄≤45岁的宫颈病灶残留率21.43%(9/42),高于年龄>45岁者的5.56%(2/36)(P<0.05)。患者的宫颈细胞学结果、宫颈活组织病理检查和高危型HPV等与LEEP术后病灶残留均无明显相关性(P>0.05)。结论 LEEP术后切缘阳性是影响宫颈病灶残留的独立危险因素,需要密切阴道镜随访,或选择再次行LEEP治疗。
Objective To investigate the feasibility and safety of cervical ring electrosurgical excision (LEEP) in the treatment of stage Ⅰa cervical squamous cell carcinoma. Methods Cervical LEEP pathological diagnosis of cervical squamous cell carcinoma stage Ⅰ 1a 78 patients underwent radical vaginal radical hysterectomy or hysterectomy combined with its clinical and pathological features of LEEP postoperative residual lesions related factors. Results Among the 78 patients, 36 cases underwent radical vaginal resection and 42 cases underwent hysterectomy. Postoperative pathological findings suggest residual lesions in 11 cases, the residual rate of 14.10%. Among them, cervical squamous cell atypical hyperplasia (CIN) Ⅱ grade in 2 cases, 6 cases of CIN Ⅲ grade, 3 cases of early cancer. The residual rate of lesions in positive margin group was 22.86% (8/35), which was higher than 6.98% (3/43) in negative margin group (P <0.05). The residual rate of cervical lesions aged ≤ 45 years was 21.43% (9/42), which was higher than that of 5.56% (2/36) (P <0.05). Cervical cytology results, cervical biopsy and high-risk HPV were not associated with postoperative LEEP lesions (P> 0.05). Conclusions The positive margins after LEEP are the independent risk factors of residual cervical lesions. They need close colposcopy follow-up or choose LEEP again.