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目的评估宫颈锥切术同时行颈管搔刮术(ECC)及锥切术后随访期间行高危型HPV-DNA检测对预测锥切术后宫颈病变残留或复发的价值。方法回顾性研究384例因中、重度宫颈上皮内瘤变接受宫颈锥切术患者的临床资料。其中108例接受了二次锥切术或全子宫切除术,对二次手术结果进行分析,评价各种预测病变残留指标的预测效能。结果接受二次手术病例中,39.8%(43/108)病例有残留或复发病灶。76.2%(32/42)ECC阳性病例有残留病灶,ECC阴性病例中16.7%(11/66)有残留病灶(OR 16.0,95%CI 6.59～35.2,P<0.01)。61.1%(33/54)HPV阳性病例再次手术标本中有残留或复发病变。HPV阴性的病例中仅4.8%(2/42)有病变残留。结论因宫颈上皮内瘤变行宫颈锥切术同时行ECC术是一种简单和可靠的对于病灶残留的预测指标,应常规开展。锥切术后随访期间的HPV检测也是有效的预测病变残留的工具,其敏感性及阴性预测价值较高。
Objective To evaluate the value of cervical conization and cervical scraping (ECC) and high-risk HPV-DNA testing during conization to predict the residual or recurrence of cervical lesions after conization. Methods A retrospective study of 384 patients with moderate and severe cervical intraepithelial neoplasia received cervical conization in patients with clinical data. Among them, 108 cases underwent secondary conization or total hysterectomy, and the results of secondary surgery were analyzed to evaluate the predictive efficacy of various predictors of residual disease. Results In the second surgery cases, 39.8% (43/108) cases had residual or recurrent lesions. There were residual lesions in 76.2% (32/42) ECC positive cases, with residual lesions in 16.7% (11/66) of ECC negative cases (OR 16.0; 95% CI 6.59-35.2, P <0.01). 61.1% (33/54) HPV-positive cases had residual or recurrent lesions in re-operation specimens. Only 4.8% (2/42) of the HPV-negative cases had residual lesions. Conclusion Concurrent cervical ECT due to cervical intraepithelial neoplasia is a simple and reliable predictor of residual lesions and should be routinely performed. Consection follow-up HPV testing during the follow-up is also an effective tool to predict the residual lesions, the sensitivity and negative predictive value is higher.