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通讯作者:

邢燕,E-mail:13951891712@163.com

中图分类号:R737.33

文献标识码:A

文章编号:1007-4368(2022)04-529-07

DOI:10.7655/NYDXBNS20220411

参考文献 1
SANTESSO N,MUSTAFA R A,WIERCIOCH W,et al.Systematic reviews and meta ⁃ analyses of benefits and harms of cryotherapy,LEEP,and cold knife conization to treat cervical intraepithelial neoplasia[J].Int J Gynaecol Obstet,2016,132(3):266-271
参考文献 2
谭先杰,吴鸣,郎景和,等.子宫颈上皮内瘤变和微小浸润癌患者子宫颈锥形切除术后病灶残留的预测因素 [J].中华医学杂志,2009,89(1):17-20
参考文献 3
KAWANO K,TSUDA N,NISHIO S,et al.Identification of appropriate cone length to avoid positive cone margin in high grade cervical intraepithelial neoplasia[J].J Gy⁃ necol Oncol,2016,27(5):e54
参考文献 4
赖爱鸾.宫颈锥切术后切缘呈阳性的临床处理建议 [J].中华妇幼临床医学杂志(电子版),2016,12(1):20-23
参考文献 5
ARBYN M,REDMAN C W E,VERDOODT F,et al.In⁃ complete excision of cervical precancer as a predictor of treatment failure:a systematic review and meta ⁃ analysis [J].Lancet Oncol,2017,18(12):1665-1679
参考文献 6
CHEN L,LIU L,TAO X,et al.Risk factor analysis of per⁃ sistent high ⁃ grade squamous intraepithelial lesion after loop electrosurgical excision procedure conization[J].J Low Genit Tract Dis,2019,23(1):24-27
参考文献 7
陈丽梅,刘莉,陶祥,等.1005例子宫颈HSIL患者行LEEP术后24个月内的复发及其影响因素分析[J].中华妇产科杂志,2019,54(8):534-540
参考文献 8
HOFFMAN S R,LE T,LOCKHART A,et al.Patterns of persistent HPV infection after treatment for cervical in⁃ traepithelial neoplasia(CIN):a systematic review[J].Int J Cancer,2017,141(1):8-23
参考文献 9
FU Y,CHEN C,FENG S,et al.Residual disease and risk factors in patients with high⁃grade cervical intraepithelial neoplasia and positive margins after initial conization[J].Ther Clin Risk Manag,2015,11:851-856
参考文献 10
KIETPEERAKOOL C,KHUNAMORNPONG S,SRISOM⁃ BOON J,et al.Cervical intraepithelial neoplasia II ⁃ III with endocervical cone margin involvement after cervical loop conization:is there any predictor for residual disease?[J].J Obstet Gynaecol Res,2007,33(5):660-664
参考文献 11
TASCI T,TURAN T,UREYEN I,et al.Is there any pre⁃ dictor for residual disease after cervical conization with positive surgical margins for HSIL or microinvasive cervi⁃ cal cancer?[J].J Low Genit Tract Dis,2015,19(2):115-118
参考文献 12
AYHAN A,TUNCER H A,REYHAN N H,et al.Risk factors for residual disease after cervical conization in pa⁃ tients with cervical intraepithelial neoplasia grades 2 and 3 and positive surgical margins[J].Eur J Obstet Gynecol Reprod Biol,2016,201:1-6
参考文献 13
SHACO ⁃LEVY R,EGER G,DREIHER J,et al.Positive margin status in uterine cervix cone specimens is associat⁃ ed with persistent/recurrent high-grade dysplasia[J].Int J Gynecol Pathol,2014,33(1):83-88
参考文献 14
ABDULAZIZ A M A,YOU X,LIU L,et al.Management of high ⁃ grade squamous intraepithelial lesion patients with positive margin after LEEP conization:a retrospec⁃ tive study[J].Medicine(Baltimore),2021,100(20):e26030
参考文献 15
DOU Y Y,ZHANG X D,LI Y,et al.Triage for manage⁃ ment of cervical high-grade squamous intraepithelial le⁃ sion patients with positive margin by conization:a retro⁃ spective analysis[J].Front Med,2017,11(2):223-228
参考文献 16
BILIBIO J P,MONEGO H I,BINDA M L A,et al.Meno⁃ pausal status is associated with a high risk for residual disease after cervical conization with positive margins[J].PLoS One,2019,14(6):e0217562
参考文献 17
ABDI F,MOBEDI H,MOSAFFA N,et al.Effects of hor⁃ mone replacement therapy on immunological factors in the postmenopausal period[J].Climacteric,2016,19(3):234-239
参考文献 18
肖银平,陶祥,赵晨燕,等.LEEP标本的切缘状态与全子宫标本中HSIL及以上病变残留关系的研究[J].中华妇产科杂志,2019,54(1):19-23
参考文献 19
PARK J Y,LEE S M,YOO C W,et al.Risk factors pre⁃ dicting residual disease in subsequent hysterectomy fol⁃ lowing conization for cervical intraepithelial neoplasia(CIN)Ⅲ and microinvasive cervical cancer[J].Gynecol Oncol,2007,107(1):39-44
目录contents

    摘要

    目的:分析宫颈高级别上皮内病变行子宫颈环形电切除术(loop electrosurgical excision procedure,LEEP)术后切缘阳性患者病变残留的高危因素,探讨不同切缘阳性患者的分层管理。方法:收集宫颈LEEP术后病理证实切缘见宫颈上皮内病变,即切缘阳性患者305例。外切缘阳性患者随访观察术后转阴情况;非外侧缘(内切缘、基底)阳性患者行二次LEEP或全子宫切除术,分析术后病灶残留的高危因素。结果:112例外切缘阳性患者6个月随访转阴率为75.9%,已绝经及切缘累及多象限与转阴负相关;孕产次、术前薄层液基细胞学检查(thin⁃prep cytologic test,TCT)结果、病变累及腺体及切缘病变级别与转阴无相关性。193例非外切缘阳性患者中,已绝经、术前TCT结果为高级别鳞状上皮内病变不典型鳞状细胞(atypical squamous cell cannot exclude high grade squamous intraepithelial lesion,ASC⁃H)或高级别鳞状上皮内病变(high⁃grade squamous intraepithelial lesion,HSIL)、切缘病变累及多象限均与病变残留正相关;年龄、孕产次、术前人乳头瘤病毒(human papilloma virus,HPV)分型及切缘病变级别均与病变残留无相关性。结论:外切缘阳性患者术后转阴率高,可行常规随访。非外切缘阳性患者已绝经、术前TCT结果为ASC⁃H或HSIL及切缘累及多象限术后病变残留率高,建议行全子宫切除术。

    Abstract

    Objective:This study aims to analyze the high risk factors of residual lesions in patients with positive cervical margin after loop electrosurgical excision procedure(LEEP)for high ⁃ grade intraepithelial cervical lesions,and to explore the stratified management of patients with different positive margins. Methods:A total of 305 patients with LEEP were collected. The postoperative specimens were pathologically confirmed to have residual cervical intraepithelial lesions at the margin of resection,namely,positive margin of conization. Routine postoperative follow ⁃ up was performed for patients with positive ectocervical margin to investigate the postoperative outcome. At the same time,all patients with positive non ⁃ectocervical margins(endocervical margin and basal margin) were treated with a second LEEP or hysterectomy,and the high⁃risk factors for postoperative residual lesions in patients with positive non ⁃ ectocervical margins were analyzed. Results:The negative conversion ratio of 112 patients with positive surgical margin was 75.9% during 6 months follow ⁃ up. Postmenopausal patients and multiple quadrants of margin involvement were inversely associated with positive ectocervical margin after conization. While the preoperative thin ⁃ prep cytology test(TCT)results,pregnancy and birth order,the degree of surgical margin lesions showed no correlation with the outcome of the patients. Among the 193 patients with positive non ⁃ectocervical margin,menopausal status,preoperative TCT results including atypical squamous cell cannot exclude high grade squamous intraepithelial lesion(ASC⁃H)and high⁃grade squamous intraepithelial lesion(HSIL),and positive margin involved multiple quadrants,all of them were positively correlated with residual lesions. While the patient’s age,gestational order,preoperative human papilloma virus(HPV)type and preoperative lesion degree showed no correlation with lesion residual. Conclusion:Routine follow ⁃ up is feasible for patients with positive ectocervical margin for the high negative conversion ratio. The probability of postoperative residual lesions in patients with positive non ⁃ectocervical margin is high in patients with menopause,the preoperative TCT show ASC⁃H or HSIL,and peripheral margin involved multiple quadrants,so hysterectomy is recommended.

  • 宫颈锥形切除术是最常见的治疗宫颈高级别鳞状上皮内病变(high⁃grade squamous intraepithelial lesion,HSIL)的方法,冷刀锥切术(cold knife conization, CKC)和子宫颈环形电切除术(loop electrosurgical excision procedure,LEEP)是常用的两种手术方式。宫颈锥形切除术可将HSIL患者发生浸润性癌的风险降低约95%,然而部分HSIL患者在术后的随访期间出现病变残留或复发[1-2]。目前一般认为术后6个月内发现宫颈病变为病变残留,术后6个月以上再次发现宫颈病变为复发[13]。宫颈锥形切除术后的病理提示切缘见宫颈上皮内病变(cervical intraepithelial lesion,CIN)为切缘阳性,切缘阳性可能意味着病变残留,进而导致病变复发。各研究中HSIL患者术后病理提示切缘阳性而发生病变残留的差异较大,引起术后病变残留的高危因素存在很多争议,同时切缘阳性患者的术后管理仍在研究探讨中[4]。本研究通过对切缘阳性患者资料的回顾性总结,分析病变残留的高危因素,并探讨不同切缘阳性患者的术后合理管理方式。

  • 1 对象和方法

  • 1.1 对象

  • 收集2016年4月—2020年4月南京医科大学第一附属医院行LEEP术患者,纳入的标准为:①LEEP术后病理为宫颈上皮内病变,并提示切缘见宫颈上皮内病变累及或切缘距病变< 1mm;②既往无宫颈疾病手术史;③无其他恶性肿瘤史。切缘阳性患者共342例,本研究纳入的患者为305例,收集患者年龄、绝经状态、孕产史、LEEP术前宫颈薄层液基细胞学检查(thin⁃prep cytologic test,TCT)及人乳头瘤病毒(human papilloma virus,HPV)检测结果、阴道镜活检病理结果、第1次LEEP术后的病理结果。本研究通过南京医科大学第一附属医院伦理委员会审核(编号:2021⁃SR⁃510),所有入组患者均知情同意。

  • 1.2 方法

  • 1.2.1 LEEP术

  • 结合术前的阴道镜评估及术中宫颈表面复方碘染色情况决定手术范围,切除至病灶外5mm以上。切除的锥体长度根据转化区的类型而定:①鳞柱交界1~2型切除锥体长度约为1cm;②鳞柱交界3型切除锥体长度达子宫颈1/3以上,为1.5~2.0cm。

  • 1.2.2 LEEP术后病理切缘的判断

  • 切缘阳性定义为LEEP术后病理证实标本切缘见宫颈上皮内病变或切缘距病变< 1mm。切缘阳性包括外切缘,内切缘及基底切缘阳性。外切缘定义为靠近阴道端的切缘;内切缘定义为靠近子宫颈管内口及宫腔段切缘;基底切缘指除外宫颈表面及内外切缘区域,本研究将内切缘及基底切缘阳性统称为非外切缘阳性。病理提示病变累及2个及以上象限为多象限。

  • 1.2.3 随访及再次手术

  • 既往多数研究认为外切缘阳性与内切缘阳性相比病变残留率明显降低。本研究对不同切缘采取分层管理,外切缘阳性患者行每6个月1次平均2年的随访,随访包括TCT联合高危型HPV检测,必要时行阴道镜活检。TCT结果依据2001年子宫颈细胞学Bethesda分类系统(TBS)进行细胞学诊断。高危型HPV检测使用Cobas 4800HPV检测仪对宫颈脱落细胞标本中HPV DNA进行分型测定。结果分为16、18及其他12种型别3类,任意一类阳性即为HPV阳性。非外切缘阳性患者在3个月内行再次手术,再次手术包括二次LEEP术及全子宫切除术 (绝经后女性宫颈萎缩,无法行二次LEEP患者则行全子宫切除术,术前均盆腔核磁检查评估宫颈浸润癌的风险)。

  • 1.2.4 病变复发与残留判断

  • 外侧缘阳性患者术后随访结果中TCT及高危HPV同时阴性或者阴道镜活检病理证实无病变视为转阴。术后6个月以上的随访中出现子宫颈上皮内病变视为复发。病变残留定义为再次手术组织病理见子宫颈上皮内病变。

  • 1.3 统计学方法

  • 采用SPSS 26.0进行统计学分析。采用例数和百分比表示计数资料,采用卡方检验和二元Logistic回归对影响转阴及病变残留的相关因素进行分析, P< 0.05为差异有统计学意义。

  • 2 结果

  • 2.1 一般临床资料

  • 本研究共纳入患者305例,年龄23~69岁,平均43岁。外切缘阳性患者占36.7%(112/305);非外切缘阳性患者占63.3%(193/305),193例中行全子宫切除术73例,二次LEEP术120例。

  • 2.2 术前TCT及HPV检查结果

  • TCT结果共归为3类,①≤低级别鳞状上皮内病变(low⁃grade squamous intraepithelial lesion,LSIL)患者183例,包括:未见上皮内病变细胞和恶性细胞 (negative for intraepithelial lesion or malignancy, NILM)34例,无明确诊断意义的不典型鳞状上皮细胞(atypical squamous cells of undetermined signifi⁃ cance,ASCUS)105例,LSIL 44例;②不能排除高级别鳞状上皮内病变不典型鳞状细胞(atypical squa⁃ mous cell cannot exclude high grade squamous intraep⁃ ithelial lesion,ASC ⁃H)44例;③HSIL 78例。患者Cobas HPV检测结果共5类,分别是HPV16型感染110例,HPV18型感染11例,其他12型HPV感染137例,HPV16型合并其他12型HPV感染41例,其他混合类型6例(16型合并18型HPV感染2例, 18型合并其他12型HPV感染2例,以及16型合并18型合并其他12型HPV感染2例)。

  • 2.3 外切缘阳性患者的转阴情况

  • 外切缘阳性患者随访中,6个月内转阴率为75.9%(85/112),12个月转阴率为83.9%(94/112), 24个月转阴率为91.9%(103/112),转阴率与随访时间呈正相关。选择年龄、绝经状态、孕产次、术前TCT及HPV、病变累及腺体(既往研究及指南提示腺体累及并非增加病变的病理分期,本研究将其作为病变复发及残留的风险因素之一)、病变累及象限及切缘病变级别等8个因素对112例患者6个月随访转阴情况进行分析。单因素分析显示:年龄> 50岁(P< 0.001)、绝经(P < 0.001)、术前的HPV分型含16型感染的患者(P=0.019)及切缘累及多象限(P=0.003)与转阴结果负相关,而孕产次、术前TCT以及切缘的病变程度与转阴无明显相关性(P> 0.05,表1)。多因素分析显示:绝经、HPV分型含16型感染及病变累及多象限与转阴负相关 (表1)。

  • 在外切缘阳性患者随访中,7.1%(8/112)患者出现复发,另有1例患者在随访6个月阴道镜活检病理示可疑宫颈原位癌,在随后全子宫切除术后组织病理提示为ⅠA2期,癌变区远离第1次锥切手术范围。

  • 2.4 非外切缘阳性患者病变残留高危因素分析

  • 非外切缘阳性患者共纳入193例,充分沟通后均要求再次手术治疗。再次手术病理提示病变残留率为57.8%(111/193),残留HSIL及以上病变为41.5%(80/111),包括浸润性癌7例。单因素分析显示:绝经(P< 0.001)、术前TCT为ASC⁃H或HSIL(P< 0.001)、病变累及腺体(P=0.032)以及切缘病变累及多象限(P< 0.001)与病变残留呈正相关。年龄、孕产次、切缘病变程度、术前HPV类型(P> 0.05)与病变残留无相关性(表2)。多因素分析显示:绝经、术前TCT为ASC⁃H或HSIL以及切缘病变累及多象限与病变残留呈正相关 (表2)。

  • 2.5 再次手术组织病理结果升级为浸润癌患者信息

  • 再次手术病理结果为浸润癌8例,其中6例已绝经。外侧缘阳性1例,非外侧缘阳性7例。再次手术方式为全子宫切除7例,1例因术前盆腔核磁共振检查提示浸润癌可能,行广泛全子宫切除。 8例患者再次术后病理根据国际妇产科联盟 (FIGO)的临床分期标准,5例为ⅠA1,1例ⅠA2, 2例ⅠB1(表3)。

  • 3 讨论

  • WHO女性生殖器肿瘤分类(2014)将宫颈上皮内病变分为LSIL和HSIL。LEEP术作为治疗宫颈高级别上皮内病变的常见治疗方法在疗效和微创方面显示出优越性,但仍有小部分患者在LEEP术后出现疾病的残留及复发。最近一项Meta分析提示LEEP术后病理切缘阳性患者为2.8%~59.5%[5]。切缘阳性可能提示病灶残留,将增加LEEP术后复发的可能性[5-6],但切缘阳性并不等于病变残留。因此,筛选病变残留高危因素,对LEEP术后切缘阳性患者选择合适的后续治疗具有指导意义。

  • 既往研究认为内切缘阳性是LEEP术后病变残留的高危因素,而外切缘阳性并不能表明病变的残留,因LEEP术切割时的热效应可达切缘外侧3~4mm,可去除部分的残留病变[7]。本研究中, 91.9%外切缘阳性患者术后24个月内转归为正常,与Hoffman等[8] 结论一致。分析显示已绝经、病变累及多象限是影响其转阴的风险因素。因此外切缘阳性患者可采取常规随访方式,而具有上述风险因素者需密切随访,必要时行阴道镜活检。

  • 表1 外侧缘阳性患者转阴分析

  • Table1 Analysis of turnning to normal in patients with positive ectocervical margin

  • *:QT12为其他12种高危型HPV。

  • 研究显示,切缘阳性患者病变残留率为11.3%~54.8%[9-11]。本研究中非外切缘阳性患者再次手术术后病理提示病变残留率为57.5%,比文献报道略有增加,可能因本研究将外切缘阳性患者另行观察,未纳入其中。本研究提示近一半内切缘阳性的患者再次手术病理未发现病变残留,可能与LEEP术中对创面进行电凝止血,对残留病变也达到了治疗的作用;LEEP术后创面的修复脱痂可致使部分的病变清除,强烈炎症反应,释放大量的免疫介质,吸引淋巴细胞和其他免疫细胞,也可能破坏残留病变[12-13]

  • Abdulaziz等[14] 研究显示,术前TCT为ASC⁃H或HSIL有利于预测病变残留情况,与本研究结论相似。Dou等[15] 的研究分析显示年龄> 35岁与病变残留显著相关,是独立危险因素,本研究未发现年龄与病变残留的相关性。而绝经状态是病变残留的高危因素,本研究中76.6%的绝经女性患者再次手术发现病变残留,与Bilibio等[16] 结论一致。绝经后女性病变残留增加的原因可能是雌激素水平过低,月经周期中分泌的雌二醇和孕酮直接或间接作用于生殖道的成纤维细胞和免疫细胞,以一种女性生殖道特定部位特有的方式改变免疫功能,雌激素水平的下降会使个体容易受到微生物的入侵和感染[17]。同时绝经后宫颈萎缩鳞柱交界上移, LEEP术时深部病变能见度不足,增加切除的难度而导致病变残留。肖银平等[18] 研究表明切缘阳性患者中多切缘阳性是病变残留的高危因素,与本研究一致。

  • 表2 非外切缘阳性患者病变残留分析

  • Table2 Analysis of residual lesions in patients with positive non⁃ectocervical margin

  • *:QT12为其他12种高危型HPV。**:其他包括16/18、16/18/QT12、18/QT12。

  • 表3 再次手术病理升级为浸润癌患者信息

  • Table3 The second operational characteristics in patients of upgrading to invasive cancer

  • *:QT12为其他12种高危型HPV。

  • 本研究中再次手术病理升级为浸润性宫颈癌的比例为2.6%,与既往研究0.9%~9.6%的发病率相当[1019]。其中6例为绝经状态,因此对于绝经后女性,病变累及多个象限发生隐匿性宫颈浸润癌的风险较高,建议行全子宫切除术前可行盆腔核磁共振检查协助诊治。

  • 综上所述,宫颈LEEP术后切缘阳性患者,可采取分层管理方式。外切缘阳性患者随访为主。非外切缘阳性且病变残留概率低者可选择随访,避免不必要的再次手术;而非绝经期存在高危因素(TCT为ASC⁃H或HSIL)患者可依据是否有生育要求及其他妇科因素选择再次LEEP术或全子宫切除术;已绝经患者术前TCT为ASC⁃H或HSIL及切缘累及多象限建议行全子宫切除术。

  • 参考文献

    • [1] SANTESSO N,MUSTAFA R A,WIERCIOCH W,et al.Systematic reviews and meta ⁃ analyses of benefits and harms of cryotherapy,LEEP,and cold knife conization to treat cervical intraepithelial neoplasia[J].Int J Gynaecol Obstet,2016,132(3):266-271

    • [2] 谭先杰,吴鸣,郎景和,等.子宫颈上皮内瘤变和微小浸润癌患者子宫颈锥形切除术后病灶残留的预测因素 [J].中华医学杂志,2009,89(1):17-20

    • [3] KAWANO K,TSUDA N,NISHIO S,et al.Identification of appropriate cone length to avoid positive cone margin in high grade cervical intraepithelial neoplasia[J].J Gy⁃ necol Oncol,2016,27(5):e54

    • [4] 赖爱鸾.宫颈锥切术后切缘呈阳性的临床处理建议 [J].中华妇幼临床医学杂志(电子版),2016,12(1):20-23

    • [5] ARBYN M,REDMAN C W E,VERDOODT F,et al.In⁃ complete excision of cervical precancer as a predictor of treatment failure:a systematic review and meta ⁃ analysis [J].Lancet Oncol,2017,18(12):1665-1679

    • [6] CHEN L,LIU L,TAO X,et al.Risk factor analysis of per⁃ sistent high ⁃ grade squamous intraepithelial lesion after loop electrosurgical excision procedure conization[J].J Low Genit Tract Dis,2019,23(1):24-27

    • [7] 陈丽梅,刘莉,陶祥,等.1005例子宫颈HSIL患者行LEEP术后24个月内的复发及其影响因素分析[J].中华妇产科杂志,2019,54(8):534-540

    • [8] HOFFMAN S R,LE T,LOCKHART A,et al.Patterns of persistent HPV infection after treatment for cervical in⁃ traepithelial neoplasia(CIN):a systematic review[J].Int J Cancer,2017,141(1):8-23

    • [9] FU Y,CHEN C,FENG S,et al.Residual disease and risk factors in patients with high⁃grade cervical intraepithelial neoplasia and positive margins after initial conization[J].Ther Clin Risk Manag,2015,11:851-856

    • [10] KIETPEERAKOOL C,KHUNAMORNPONG S,SRISOM⁃ BOON J,et al.Cervical intraepithelial neoplasia II ⁃ III with endocervical cone margin involvement after cervical loop conization:is there any predictor for residual disease?[J].J Obstet Gynaecol Res,2007,33(5):660-664

    • [11] TASCI T,TURAN T,UREYEN I,et al.Is there any pre⁃ dictor for residual disease after cervical conization with positive surgical margins for HSIL or microinvasive cervi⁃ cal cancer?[J].J Low Genit Tract Dis,2015,19(2):115-118

    • [12] AYHAN A,TUNCER H A,REYHAN N H,et al.Risk factors for residual disease after cervical conization in pa⁃ tients with cervical intraepithelial neoplasia grades 2 and 3 and positive surgical margins[J].Eur J Obstet Gynecol Reprod Biol,2016,201:1-6

    • [13] SHACO ⁃LEVY R,EGER G,DREIHER J,et al.Positive margin status in uterine cervix cone specimens is associat⁃ ed with persistent/recurrent high-grade dysplasia[J].Int J Gynecol Pathol,2014,33(1):83-88

    • [14] ABDULAZIZ A M A,YOU X,LIU L,et al.Management of high ⁃ grade squamous intraepithelial lesion patients with positive margin after LEEP conization:a retrospec⁃ tive study[J].Medicine(Baltimore),2021,100(20):e26030

    • [15] DOU Y Y,ZHANG X D,LI Y,et al.Triage for manage⁃ ment of cervical high-grade squamous intraepithelial le⁃ sion patients with positive margin by conization:a retro⁃ spective analysis[J].Front Med,2017,11(2):223-228

    • [16] BILIBIO J P,MONEGO H I,BINDA M L A,et al.Meno⁃ pausal status is associated with a high risk for residual disease after cervical conization with positive margins[J].PLoS One,2019,14(6):e0217562

    • [17] ABDI F,MOBEDI H,MOSAFFA N,et al.Effects of hor⁃ mone replacement therapy on immunological factors in the postmenopausal period[J].Climacteric,2016,19(3):234-239

    • [18] 肖银平,陶祥,赵晨燕,等.LEEP标本的切缘状态与全子宫标本中HSIL及以上病变残留关系的研究[J].中华妇产科杂志,2019,54(1):19-23

    • [19] PARK J Y,LEE S M,YOO C W,et al.Risk factors pre⁃ dicting residual disease in subsequent hysterectomy fol⁃ lowing conization for cervical intraepithelial neoplasia(CIN)Ⅲ and microinvasive cervical cancer[J].Gynecol Oncol,2007,107(1):39-44

  • 参考文献

    • [1] SANTESSO N,MUSTAFA R A,WIERCIOCH W,et al.Systematic reviews and meta ⁃ analyses of benefits and harms of cryotherapy,LEEP,and cold knife conization to treat cervical intraepithelial neoplasia[J].Int J Gynaecol Obstet,2016,132(3):266-271

    • [2] 谭先杰,吴鸣,郎景和,等.子宫颈上皮内瘤变和微小浸润癌患者子宫颈锥形切除术后病灶残留的预测因素 [J].中华医学杂志,2009,89(1):17-20

    • [3] KAWANO K,TSUDA N,NISHIO S,et al.Identification of appropriate cone length to avoid positive cone margin in high grade cervical intraepithelial neoplasia[J].J Gy⁃ necol Oncol,2016,27(5):e54

    • [4] 赖爱鸾.宫颈锥切术后切缘呈阳性的临床处理建议 [J].中华妇幼临床医学杂志(电子版),2016,12(1):20-23

    • [5] ARBYN M,REDMAN C W E,VERDOODT F,et al.In⁃ complete excision of cervical precancer as a predictor of treatment failure:a systematic review and meta ⁃ analysis [J].Lancet Oncol,2017,18(12):1665-1679

    • [6] CHEN L,LIU L,TAO X,et al.Risk factor analysis of per⁃ sistent high ⁃ grade squamous intraepithelial lesion after loop electrosurgical excision procedure conization[J].J Low Genit Tract Dis,2019,23(1):24-27

    • [7] 陈丽梅,刘莉,陶祥,等.1005例子宫颈HSIL患者行LEEP术后24个月内的复发及其影响因素分析[J].中华妇产科杂志,2019,54(8):534-540

    • [8] HOFFMAN S R,LE T,LOCKHART A,et al.Patterns of persistent HPV infection after treatment for cervical in⁃ traepithelial neoplasia(CIN):a systematic review[J].Int J Cancer,2017,141(1):8-23

    • [9] FU Y,CHEN C,FENG S,et al.Residual disease and risk factors in patients with high⁃grade cervical intraepithelial neoplasia and positive margins after initial conization[J].Ther Clin Risk Manag,2015,11:851-856

    • [10] KIETPEERAKOOL C,KHUNAMORNPONG S,SRISOM⁃ BOON J,et al.Cervical intraepithelial neoplasia II ⁃ III with endocervical cone margin involvement after cervical loop conization:is there any predictor for residual disease?[J].J Obstet Gynaecol Res,2007,33(5):660-664

    • [11] TASCI T,TURAN T,UREYEN I,et al.Is there any pre⁃ dictor for residual disease after cervical conization with positive surgical margins for HSIL or microinvasive cervi⁃ cal cancer?[J].J Low Genit Tract Dis,2015,19(2):115-118

    • [12] AYHAN A,TUNCER H A,REYHAN N H,et al.Risk factors for residual disease after cervical conization in pa⁃ tients with cervical intraepithelial neoplasia grades 2 and 3 and positive surgical margins[J].Eur J Obstet Gynecol Reprod Biol,2016,201:1-6

    • [13] SHACO ⁃LEVY R,EGER G,DREIHER J,et al.Positive margin status in uterine cervix cone specimens is associat⁃ ed with persistent/recurrent high-grade dysplasia[J].Int J Gynecol Pathol,2014,33(1):83-88

    • [14] ABDULAZIZ A M A,YOU X,LIU L,et al.Management of high ⁃ grade squamous intraepithelial lesion patients with positive margin after LEEP conization:a retrospec⁃ tive study[J].Medicine(Baltimore),2021,100(20):e26030

    • [15] DOU Y Y,ZHANG X D,LI Y,et al.Triage for manage⁃ ment of cervical high-grade squamous intraepithelial le⁃ sion patients with positive margin by conization:a retro⁃ spective analysis[J].Front Med,2017,11(2):223-228

    • [16] BILIBIO J P,MONEGO H I,BINDA M L A,et al.Meno⁃ pausal status is associated with a high risk for residual disease after cervical conization with positive margins[J].PLoS One,2019,14(6):e0217562

    • [17] ABDI F,MOBEDI H,MOSAFFA N,et al.Effects of hor⁃ mone replacement therapy on immunological factors in the postmenopausal period[J].Climacteric,2016,19(3):234-239

    • [18] 肖银平,陶祥,赵晨燕,等.LEEP标本的切缘状态与全子宫标本中HSIL及以上病变残留关系的研究[J].中华妇产科杂志,2019,54(1):19-23

    • [19] PARK J Y,LEE S M,YOO C W,et al.Risk factors pre⁃ dicting residual disease in subsequent hysterectomy fol⁃ lowing conization for cervical intraepithelial neoplasia(CIN)Ⅲ and microinvasive cervical cancer[J].Gynecol Oncol,2007,107(1):39-44

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