Objective: To analyze clinical outcome of high grade squamous intraepithelial lesion (HSIL) within 24 months after loop electrosurgical excision procedure (LEEP), and to explore risk factors of recurrent cervical HSIL, the risk of progress into cervical cancer and methods of follow-up. Methods: This retrospective study was carried out on 1 005 patients who underwent LEEP, diagnosing with HSIL after LEEP from January 2011 to December 2013 at Obstetrics and Gynecology Hospital Affiliated to Fudan University to confer the difference between non-recurrent group and recurrent group 24 months after the LEEP conization. Patients were followed with ThinPrep cytologic test (TCT), high risk HPV (HR-HPV) test, colposcopy guided biopsy. Results: A total of 1 005 cases were enrolled in this study with HSIL in the LEEP specimen, no residual HSIL in the 6-month follow up, and have follow up records in 24 months after LEEP. HSIL recurred in 5 cases, microinvasive carcinoma in 1 case, low grade squamous intraepithelial lesion (LSIL) in 17 cases at 12 months follow-up. HSIL recurred in 8 cases, LSIL in 11 cases, adenocarcinoma in situ in 1 case, and invasive cervical carcinoma in 1 case in Ⅰb1 stage at 24 months after LEEP. The recurrence rate was 1.3% (13/1 005) , and the progression rate was 0.3% (3/1 005) . There was no significant difference in age, length, circumference and width of LEEP between recurrent and non-recurrent patients (P>0.05) . The recurrence rate was highest in the endocervical positive margin group with 3/16, which was higher than ectocervical positive margin and negative margin (P<0.01, P=0.040, respectively). The recurrence rate of endocervical positive margin group and fibrous interstitial positive margin group showed no significant difference (P=0.320) . There was no significant difference between ectocervical positive margin and negative margin [2.8% (2/72) vs 0.7% (6/882), P=0.117]. Postoperative cytological examination combined with HR-HPV detection has a high sensitive and high negative predictor value of HSIL recurrence with both 100.0%. Multivariate logistic regression analysis showed that positive endocervical positive margin, abnormal follow-up cytological examination and positive HR-HPV after LEEP were independent factors affecting recurrence of HSIL patients after LEEP (P<0.05). Conclusions: Age, length, circumference and width of LEEP have no effect on recurrence within 24 months after HSIL. The high risk factors for HSIL recurrence within 24 months after LEEP in HSIL patients include: positive HPV, abnormal cytology, and positive endocervical positive margin. Colposcopy biopsy and endocervical curettage have important role in diagnosing HSIL recurrence and progression.
目的： 探讨子宫颈高级别鳞状上皮内病变（HSIL）患者行子宫颈环形电极切除（LEEP）术后24个月的复发情况，并对影响复发的因素进行分析。 方法： 收集2011年1月—2013年12月在复旦大学附属妇产科医院行LEEP术且术后诊断为HSIL、术后6个月内随访阴道镜检查为无残留且有术后24个月随访资料的患者共1 005例，LEEP术后随访内容包括细胞学检查、高危型HPV（HR-HPV）检测、阴道镜下子宫颈活检，随访时间为术后4~6、12、24个月。（1）分析HSIL患者LEEP术后的复发情况；（2）比较复发与未复发患者之间的年龄及LEEP术锥切标本参数（包括长度、宽度和周长）的差异；（3）比较HSIL患者LEEP术后不同切缘状态的复发率；（4）探讨不同随访方法对复发的预测价值；（5）分析影响复发的危险因素。 结果： （1）1 005例HSIL行LEEP术的患者中，术后12个月随访发现复发5例、进展为微小浸润癌1例、LSIL 17例，继续随访至术后24个月又发现复发8例、LSIL 11例、进展为原位腺癌1例和子宫颈癌Ⅰb1期1例。LEEP术后24个月的累计复发患者13例，复发率为1.3%（13/1 005）；累计进展患者3例，进展率为0.3%（3/1 005）。（2）复发患者的年龄以及LEEP术锥切标本的长度、宽度和周长分别与未复发患者比较，差异均无统计学意义（P>0.05）。（3）内切缘阳性患者的复发率为3/16，与纤维间质切缘阳性者（6.5%，2/31）比较无显著差异（P=0.320）；外切缘阳性患者的复发率为2.8%（2/72），与切缘阴性者（0.7%，6/882）比较也无显著差异（P=0.117）；内切缘阳性患者的复发率分别与切缘阴性者和外切缘阳性者相比均显著升高（P<0.01，P=0.040）。（4）术后细胞学检查联合HR-HPV检测预测HSIL复发的敏感度和阴性预测值均为100.0%。（5）logistics回归模型多因素分析显示，LEEP术后内切缘阳性、术后随访细胞学检查异常、术后随访HR-HPV阳性均为影响HSIL患者LEEP术后复发的独立因素（P<0.05）。 结论： LEEP术后24个月的复发率为1.3%，年龄及锥切标本的长度、宽度和周长对HSIL患者LEEP术后24个月内复发无显著影响，内切缘阳性以及术后细胞学检查异常、HR-HPV阳性均为影响HSIL患者LEEP术后复发的独立因素。.
Keywords: Electrosurgery; Gynecologic surgical procedures; Neoplasm recurrence, local; Papillomaviridae; Risk factors; Squamous intraepithelial lesions of the cervix; Vaginal smears.