Page 79 - 南京医科大学学报自然科学版

第42卷第4期 南京医科大学学报（自然科学版）
2022年4月 Journal of Nanjing Medical University（Natural Sciences） ·529 ·

·临床研究·

LEEP术后不同切缘阳性患者的分层管理及临床预后

钱 程，袁书凝，谢满鑫，邢 燕 *
南京医科大学第一附属医院妇科，江苏 南京 210029

［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。
［关键词］ 子宫颈环形电切除术；切缘阳性；高危因素
［中图分类号］ R737.33 ［文献标志码］ A ［文章编号］ 1007⁃4368（2022）04⁃529⁃07
doi：10.7655/NYDXBNS20220411

Stratified management and clinical prognosis of patients with differently positive surgical
margins after LEEP

*
QIAN Cheng，YUAN Shuning，XIE Manxin，XING Yan
Department of Gynecology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［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

［基金项目］ 江苏省卫健委面上项目（H2019009）
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通信作者（Corresponding author），E⁃mail：13951891712@163.com