全球精选文摘 - LEEP锥切术后又全子宫切除术后残端疾病预测的病理风险因素

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LEEP锥切术后又全子宫切除术后残端疾病预测的病理风险因素

Pathologic risk factors for predicting residual disease in subsequent hysterectomy following LEEP conization

Kim H-J, Kim K-R, Mok JE 2009/5/27 10:50:39

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Gynecol Oncol, 2007,

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Abstract

Objective:

The loop electrosurgical excision procedure (LEEP) is widely used for cervical conization. It is unclear if margin status is the single most important factor for predicting residual or recurrent disease. We therefore sought to determine supplementary histologic factors that can be used to predict residual disease in subsequent hysterectomy specimens in order to select patients at high risk for residual and recurrent disease.

Methods:

The study group comprised 172 women who had undergone LEEP conization and subsequent hysterectomy. Histological findings were assessed and compared in patients with and without residual disease.

Results:

A univariate analysis revealed that percentage of involved pieces (51% vs. 32%, p<0.001), percentage of involved mucosal length (30% vs. 17%, p=0.001), positive endocervical biopsy (77% vs. 45%, p<0.001), bulbous growth (73% vs. 44%, p=0.001), pseudogland or central necrosis (73% vs. 26%, p<0.001), and severe degree of nuclear atypia (17% vs. 4%, p=0.043) were significantly more frequent in patients with residual tumors among 140 resection margin positive patients, but mitotic count, severe inflammatory cell infiltration, endocervical glandular extension, and cytoplasmic maturation did not differ significantly between the two groups. Multivariate analysis revealed that positive endocervical biopsy, bulbous growth, and central necrosis were associated with residual disease in the resection margin positive patients.

Conclusion:

In patients with positive LEEP margins in young women who want to preserve her fertility, negative endocervical biopsy, and the absence of bulbous growth or central necrosis can be used as selection criteria for patients who can defer the additional surgery and be closely followed with colposcopic and cytologic examination. Even in samples with negative LEEP margins, the patients who have those histologic parameters may need more careful monitoring for residual tumor or tumor recurrence.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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