李岩;崔竹梅;娄艳辉;刘丽芝;唐蕊;韩汶君;

• 1:青岛大学医学院附属医院妇科

摘要(Abstract)：

目的:探讨高危型HPV(HR-HPV)DNA检测在宫颈上皮内瘤变(CIN)及宫颈鳞癌(ⅠA1期)患者经宫颈冷刀锥切术治疗后随访中的应用及意义。方法:2008年1月至2010年10月我院收治的308例CINⅡ～Ⅲ及宫颈鳞癌(ⅠA1期)患者经宫颈冷刀锥切术治疗后,采用第二代杂交捕获试验(HC2)检测HR-HPV DNA联合液基细胞学随访,观察术后HR-HPV清除及宫颈病变复发情况,并分析术后HR-HPV持续感染及病变持续或复发的相关因素。结果:至随访结束,宫颈锥切术后病变持续或复发者共10例。术后病变持续或复发在HR-HPV持续感染组中明显多于HR-HPV转阴组(P<0.001);术前HR-HPV DNA高负荷、病变累及3～4个象限为术后HR-HPV持续感染的高危因素;术前HR-HPV DNA≥500RIUs/CO是术后病变持续或复发的独立危险因素。结论:HR-HPV持续感染是宫颈锥切术后病变持续或复发的重要因素,术前HR-HPV DNA高负荷是术后HR-HPV持续感染及病变持续或复发的独立危险因素,术后应重点随访。

关键词(KeyWords)： 宫颈肿瘤;宫颈上皮内瘤样病变;人乳头瘤病毒;高危型HPVDNA检测;宫颈锥切术;持续感染;病灶持续;复发

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 李岩;崔竹梅;娄艳辉;刘丽芝;唐蕊;韩汶君;

DOI: 10.13283/j.cnki.xdfckjz.2012.08.007

参考文献(References)：

• [1]Munoz N,Bosch FX,De Sanjose,et al.Epidemiologic clas-sification of human papillomavirus types association withcervical cancer[J].N Eng J Med,2003,348(6):518-527
• [2]Munoz N.Human papillomavirus and cancer:the epidemi-ological evidence[J].J Clin Virol,2000,19(1-2):1-5
• [3]Alonso I,Torn A,Puig-Tintor LM,et al.Pre-and post-conization high-risk HPV testing predicts residual/recur-rent disease in patients treated for CIN2-3[J].GynecolOncol,2006,103(2):631-636
• [4]Song SH,Lee JK,Oh MJ,et al.Persistent HPV infectionafter conization in patients with negative margins[J].Gy-necol Oncol,2006,101(3):418-422
• [5]Park JY,Lee KH,Dong SM,et al.The association of pre-conization high-risk HPV load and the persistence of HPVinfection and persistence/recurrence of cervical intraepi-thelial neoplasia after conization[J].Gynecol Oncol,2008,108(3):549-554
• [6]Kim YT,Lee JM,Hur SY,et al.Clearance of human papil-lomavirus infection after successful conization in patientswith cervical intraepithelial neoplasia[J].Int J Cancer,2010,126(8):1903-1909
• [7]Paraskevaidis E,Arbyn M,Sotiriadis A,et al.The role ofHPV DNA testing in the follow-up period after treatmentfor CIN:a systematic review of the literature[J].CancerTreat Rev,2004,30(2):205-211
• [8]Jain S,Tseng CJ,Horng SG,et al.Negative predictive val-ue of human papillomavirus test following conization of thecervix uteri[J].Gynecol Oncol,2001,82(1):177-180
• [9]谢幸.宫颈上皮内瘤变的处理策略[J].中华医学杂志,2006,86(5):289-290
• [10]Park JY,Lee SM,Yoo CW,et al.Risk factors predictingresidual disease in subsequent hysterectomy followingconization for cervical intraepithelial neoplasia(CIN)IIIand microinvasive cervical cancer[J].Gynecol Oncol,2007,107(1):39-44
• [11]Josefsson AM,Magnusson PK,Ylitalo N,et al.Viral loadof human papilloma virus 16 as a determinant for devel-opment of cervical carcinoma in situ:a nested case-con-trol study[J].Lancet,2000,355(9222):2189-2193
• [12]Lu CH,Liu FS,Tseng JJ,et al.Predictive factors for re-sidual disease in subsequent hysterectomy followingconization for CINⅢ[J].Gynecol Oncol,2000,79(2):284-288
• [13]Livasy CA,Maygarden SJ,Rajaratnam CT,et al.Predic-tors of recurrent dysplasia after a cervical loop electro-cautery excision procedure for CINⅢ:a study of margin,endocervical gland,and quadrant involvement[J].ModPathol,1999,12(3):233-238