宫颈高度鳞状上皮内病变的治疗现状
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摘要
宫颈上皮内病变是与宫颈癌密切相关的病变,目前治疗方法以宫颈锥切为主,其余疗法应用不多且治疗效果有待考证,本文介绍宫颈高度鳞状上皮内病变治疗现状,旨在对治疗宫颈上皮内病变有一定参考价值。
Cervical intraepithelial lesions are closely related to cervical cancer. The current treatment is based on cervical conization. The rest of the therapies are not widely used and the treatment effect is yet to be validated. This article describes the current status of cervical squamous intraepithelial lesions and the purpose is to provide some reference value for the treatment of cervical intraepithelial lesions.
Cervical intraepithelial lesions are closely related to cervical cancer. The current treatment is based on cervical conization. The rest of the therapies are not widely used and the treatment effect is yet to be validated. This article describes the current status of cervical squamous intraepithelial lesions and the purpose is to provide some reference value for the treatment of cervical intraepithelial lesions.
引文
[1]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[2]Lu Z,Chen J.Introduction of WHO classification of tumours of female reproductive organs,fourth edition[J].Chinese Journal of Pathology,2014,43(10):649-650.
[3]Women's Health Club of Chinese Preventive Medicine Association.Guidelines for comprehensive prevention and control of cervical cancer[M].Beijing:People's Health Publishing House,2017:45-48.[中华预防医学会妇女保健分会.子宫颈癌综合防控指南[M].北京:人民卫生出版社,2017:45-48.]
[4]Xie X,Gou WL,Lin ZQ,et al.Cervical intraepithelial neoplasia[M].Beijing:People's Health Publishing House,2012:301-304.[谢幸,苟文丽,林种秋,等.子宫颈上皮内瘤变[M].北京:人民卫生出版社,2012:301-304.]
[5]Shen K,Lang JH,Huang HF,et al.Evaluation of cervical conization diagnosis and management of cervical intraepithelial neoplasias[J].Chinese Journal of Obstetrics and Gynecology,2001,36(05):264-266.[沈铿,郎景和,黄惠芳,等.子宫颈锥切术在子宫颈上皮内瘤变诊断和治疗中的价值[J].中华妇产科杂志,2001,36(05):264-266.]
[6]Ghaem-Maghami S,De-Silva D,Tipples M,et al.Determinants of success in treating cervical intraepithelial neoplasia[J].Br J Obster Gynaecol,2011,118:679-684.
[7]Nancy Santesso,Reem A,Mustafa,et al.Systematic reviews and meta-analyses of benefits and harms of cryotherapy,LEEP,and cold knife conization to treat cervical intraepithelial neoplasia[J].International Journal of Gynecology and Obstetrics,2016,132:266-271.
[8]Mazouni C,Porcu G,Haddad O,et al.Conservative treatment of cervical intraepithelial neoplasia using a cold-knife section technique[J].Eur J Obstet Gynecol Reprod Biol,2005,121(1):86-93.
[9]Wu J,Jia Y,Luo M,et al.Analysis of residual/recurrent disease and its risk factors after loop electrosurgical excision procedure for high-grade cervical intraepithelial neoplasia[J].Gynecol Obstet Invest,2016,81:296-301.
[10]Jiang Y,Chen C,Li L.Comparison of cold-knife conization versus loop electrosurgical excision for cervical adenocarcinoma in situ(ACIS):A systematic review and meta-analysis[J].Plos One,2017,12(1):e0170587.
[11]YM Jiang,CX Chen,L Li.Meta-analysis of cold-knife conization versus loop electrosurgical excision procedure for cervical intraepithelial neoplasia[J].Onco Targets Ther,2016,9:3907-3915.
[12]Sangkarat S,Ruengkhachorn I.Long-term outcomes of a loop electrosurgical excision procedure for cervical intraepithelial neoplasia in a high incidence country[J].Asian Pac J Cancer Prev,2014,15(2):1035-1039.
[13]El-Nashar SA,Shazly SA,Hopkins MR,et al.Loop electrosurgical excision procedure instead of cold-knife conization for cervical intraepithelial neoplasia in women with unsatisfactory colposcopic examinations:A systematic review and meta-analysis[J].Journal of Lower Genital Tract Disease,2017,21(2):129.
[14]Tan XJ,Wu M,Lang JH,et al.Issues associated with cervical conization:Analysis of 390 cases[J].Chinese Journal of Clinical Oncology,2009,36(18):1071-1075.[谭先杰,吴鸣,郎景和,等.子宫颈锥形切除术相关问题探讨(附390例临床分析)[J].中国肿瘤临床,2009,36(18):1071-1075.]
[15]Cuello MA,Espinosa ME,Orlandini EJ,et al.The value of endocervical curettage during loop electrosurgical excision procedures in predicting persistent/recurrent preinvasive cervical disease[J].International Journal of Gynaecology&Obstetrics,2018,141(3):337-343.
[16]Baser E,Ozgu E,Erkilinc S.Clinical outcomes of cases with absent cervical dysplasia in cold knife conization specimens[J].Asian Pac J Cancer Prev,2014,14(11):6693-6696.
[17]z M,Cetinkaya N,Korkmaz E.Optimal cone size to predict positive surgical margins after cold knife conization(CKC)and the risk factors for residual disease[J].J Turk Ger Gynecol Assoc,2016,17(3):159-162.
[18]Park JY,Lee SM,Yoo CW,et al.Risk factors predicting residual disease in subsequent hyst erect omy following conization for cervical int raepithelial neoplasia CIN3 and microin vasive cervical cancer[J].Gynecol Oncol,2007,107:830-840.
[19]Li ZN,Wu D,Ding L,et al.Clinicopathological analysis of 2098cases of cervical intraepithelial neoplasia of the cervix[J].Journal of Practical Obstetrics and Gynecology,2012,28(2):150-152.[李柱南,吴丹,丁李,等.宫颈上皮内瘤变宫颈环形电切术后2098例标本切缘阳性的临床病理分析[J].实用妇产科杂志,2012,28(2):150-152.]
[20]Liu L,Chen LM,Tao X,et al.Clinical outcome and high risk factor for residual lesion analysis of HSIL half a year after loop electrosurgical excision procedure:a clinical study of 1 502 cases[J].Chinese Journal of Obstetrics and Gynecology,2017,52(11):751-756.[刘莉,陈丽梅,陶祥,等.1 502例子宫颈HSIL患者行LEEP锥切术后随访半年的临床结局及术后病灶残留的危险因素分析[J].中华妇产科杂志,2017,52(11):751-756.]
[21]Yingyongwatthanawitthaya T,Chirdchim W,Thamrongwuttikul C,et al.Risk factors for incomplete excision after loop electrosurgical excision procedure(LEEP)in abnormal cervical cytology[J].A-sian Pacific Journal of Cancer Prevention,2017,18(9):2569.
[22]Leite PM,Tafuri L,Costa MZ,et al.Evaluation of the p16 and Ki-67 biomarkers as predictors of the recurrence of premalignant cervical cancer lesions after LEEP conization[J].Revista Brasileira De Ginecologia E Obstetrícia,2017,39(06):288-293.
[23]Shen K.Selection of treatment methods for cervical intraepithelial neoplasia[J].National Medical Journal of China,2006,85(5):291-294.[沈铿.宫颈上皮内瘤变治疗方法的选择[J].中华医学杂志,2006,85(5):291-294.]
[24]He XM,You ZX.The 2013 WHO guidelines for cervical cancer screening and treatment programmes[J].Progress in Obstetrics and Gynecology,2015,24(3):220-223.[何晓明,尤志学.2013年WHO宫颈癌筛查及处理方案指南的解读[J].现代妇产科进展,2015,24(3):220-223.]
[25]Nam KH,Kwon JY,Kim YH,et al.Pregnancy outcome after cervical conization:risk factors for preterm delivery and the efficacy of prophylactic cerclage[J].J Gynecol Oncol,2010,21(4):225-229.
[26]Zebitay AG,Güng9r ES,Ilhan G,et al.Cervical conization and the risk of preterm birth:A population-based multicentric trial of turkish cohort[J].J Clin Diagn Res,2017,11(3):21-24.
[27]Boulanger JC,Gondry J,Verhoest P,et al.Treatmentof CIN aftermenopause[J].Eur J Obstet Gynecol Reprod Biol,2001,95(2):175-180.
[28]Wang RM,Peng JJ,You ZX.The interpretation of 2012 ASCCPmanagement of abnormal cervical cancer screening tests and cancer precursors(Ⅱ)[J].Journal of International Obstetrics and Gynecology,2015,42(2):238-240.[王荣敏,彭晶晶,尤志学.对ASCCP 2012年宫颈癌筛查和癌前病变管理指南的解读(二)[J].国际妇产科学杂志,2015,42(2):238-240.]
[29]Wongtiraporn W,Laiwejpithaya S.Long term outcomes of laser conization for high grade cervical intraepithelial neoplasia in thai women[J].Asian Pacific Journal of Cancer Prevention,2014,15(18):7757-7761.
[30]Fambrini M,Penna C,Pieralli A.CO2laser cylindrical excision or standard re-conization for persistent-recurrent high-grade cervical intraepithelial neoplasia(HG-CIN)in women of fertile age[J].Anticancer Res,2008,28(6B):3871-3875.
[31]M Arbyn.Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia:Meta-analysis[J].BMJ,2008,337:a1284.
[32]Inaba K,Nagasaka K.High-risk human papillomavirus correlates with recurrence after laser ablation for treatment of patients with cervical intraepithelial neoplasia 3:A long-term follow-up retrospective study[J].J Obstet Gynaecol Res,2014,40(2):554-560.
[33]Bruinsma FJ,Quinn MA.The risk of preterm birth following treatment for precancerous changes in the cervix:A systematic review and meta-analysis[J].BJOG,2011,118(9):1031-1041.
[34]Sauvaget C,Muwonge R,Sankaranarayanan R.Meta-analysis of the effectiveness of cryotherapy in the treatment of cervical intraepithelial neoplasia[J].International Journal of Gynaecology&Obstet,2013,120(3):218-223.
[35]Santesso N,Schünemann H,Blumenthal P,et al.World Health Organization Guidelines:Use of cryotherapy for cervical intraepithelial neoplasia[J].International Journal of Gynecology&Obstetrics,2012,118(2):97-102.
[36]Koizumi K,Fujioka T.Clinical investigation of the safety and efficacy of a cervical intraepithelial neoplasia treatment using a hyperthermia device that uses heat induced by alternating magnetic fields[J].Mol Clin Oncol,2016,5(2):310-316.
[37]Nowak-Stepniowska A,Pergol P,Padzik-Graczyk A.Photodynamic method of cancer diagnosis and therapy-mechanisms and applications[J].Postepy Biochem,2013,59:53-63.
[38]YK Park,CH Park.Clinical efficacy of photodynamic therapy[J].Obstetrics&Gynecology Science,2016,59(6):479.
[2]Lu Z,Chen J.Introduction of WHO classification of tumours of female reproductive organs,fourth edition[J].Chinese Journal of Pathology,2014,43(10):649-650.
[3]Women's Health Club of Chinese Preventive Medicine Association.Guidelines for comprehensive prevention and control of cervical cancer[M].Beijing:People's Health Publishing House,2017:45-48.[中华预防医学会妇女保健分会.子宫颈癌综合防控指南[M].北京:人民卫生出版社,2017:45-48.]
[4]Xie X,Gou WL,Lin ZQ,et al.Cervical intraepithelial neoplasia[M].Beijing:People's Health Publishing House,2012:301-304.[谢幸,苟文丽,林种秋,等.子宫颈上皮内瘤变[M].北京:人民卫生出版社,2012:301-304.]
[5]Shen K,Lang JH,Huang HF,et al.Evaluation of cervical conization diagnosis and management of cervical intraepithelial neoplasias[J].Chinese Journal of Obstetrics and Gynecology,2001,36(05):264-266.[沈铿,郎景和,黄惠芳,等.子宫颈锥切术在子宫颈上皮内瘤变诊断和治疗中的价值[J].中华妇产科杂志,2001,36(05):264-266.]
[6]Ghaem-Maghami S,De-Silva D,Tipples M,et al.Determinants of success in treating cervical intraepithelial neoplasia[J].Br J Obster Gynaecol,2011,118:679-684.
[7]Nancy Santesso,Reem A,Mustafa,et al.Systematic reviews and meta-analyses of benefits and harms of cryotherapy,LEEP,and cold knife conization to treat cervical intraepithelial neoplasia[J].International Journal of Gynecology and Obstetrics,2016,132:266-271.
[8]Mazouni C,Porcu G,Haddad O,et al.Conservative treatment of cervical intraepithelial neoplasia using a cold-knife section technique[J].Eur J Obstet Gynecol Reprod Biol,2005,121(1):86-93.
[9]Wu J,Jia Y,Luo M,et al.Analysis of residual/recurrent disease and its risk factors after loop electrosurgical excision procedure for high-grade cervical intraepithelial neoplasia[J].Gynecol Obstet Invest,2016,81:296-301.
[10]Jiang Y,Chen C,Li L.Comparison of cold-knife conization versus loop electrosurgical excision for cervical adenocarcinoma in situ(ACIS):A systematic review and meta-analysis[J].Plos One,2017,12(1):e0170587.
[11]YM Jiang,CX Chen,L Li.Meta-analysis of cold-knife conization versus loop electrosurgical excision procedure for cervical intraepithelial neoplasia[J].Onco Targets Ther,2016,9:3907-3915.
[12]Sangkarat S,Ruengkhachorn I.Long-term outcomes of a loop electrosurgical excision procedure for cervical intraepithelial neoplasia in a high incidence country[J].Asian Pac J Cancer Prev,2014,15(2):1035-1039.
[13]El-Nashar SA,Shazly SA,Hopkins MR,et al.Loop electrosurgical excision procedure instead of cold-knife conization for cervical intraepithelial neoplasia in women with unsatisfactory colposcopic examinations:A systematic review and meta-analysis[J].Journal of Lower Genital Tract Disease,2017,21(2):129.
[14]Tan XJ,Wu M,Lang JH,et al.Issues associated with cervical conization:Analysis of 390 cases[J].Chinese Journal of Clinical Oncology,2009,36(18):1071-1075.[谭先杰,吴鸣,郎景和,等.子宫颈锥形切除术相关问题探讨(附390例临床分析)[J].中国肿瘤临床,2009,36(18):1071-1075.]
[15]Cuello MA,Espinosa ME,Orlandini EJ,et al.The value of endocervical curettage during loop electrosurgical excision procedures in predicting persistent/recurrent preinvasive cervical disease[J].International Journal of Gynaecology&Obstetrics,2018,141(3):337-343.
[16]Baser E,Ozgu E,Erkilinc S.Clinical outcomes of cases with absent cervical dysplasia in cold knife conization specimens[J].Asian Pac J Cancer Prev,2014,14(11):6693-6696.
[17]z M,Cetinkaya N,Korkmaz E.Optimal cone size to predict positive surgical margins after cold knife conization(CKC)and the risk factors for residual disease[J].J Turk Ger Gynecol Assoc,2016,17(3):159-162.
[18]Park JY,Lee SM,Yoo CW,et al.Risk factors predicting residual disease in subsequent hyst erect omy following conization for cervical int raepithelial neoplasia CIN3 and microin vasive cervical cancer[J].Gynecol Oncol,2007,107:830-840.
[19]Li ZN,Wu D,Ding L,et al.Clinicopathological analysis of 2098cases of cervical intraepithelial neoplasia of the cervix[J].Journal of Practical Obstetrics and Gynecology,2012,28(2):150-152.[李柱南,吴丹,丁李,等.宫颈上皮内瘤变宫颈环形电切术后2098例标本切缘阳性的临床病理分析[J].实用妇产科杂志,2012,28(2):150-152.]
[20]Liu L,Chen LM,Tao X,et al.Clinical outcome and high risk factor for residual lesion analysis of HSIL half a year after loop electrosurgical excision procedure:a clinical study of 1 502 cases[J].Chinese Journal of Obstetrics and Gynecology,2017,52(11):751-756.[刘莉,陈丽梅,陶祥,等.1 502例子宫颈HSIL患者行LEEP锥切术后随访半年的临床结局及术后病灶残留的危险因素分析[J].中华妇产科杂志,2017,52(11):751-756.]
[21]Yingyongwatthanawitthaya T,Chirdchim W,Thamrongwuttikul C,et al.Risk factors for incomplete excision after loop electrosurgical excision procedure(LEEP)in abnormal cervical cytology[J].A-sian Pacific Journal of Cancer Prevention,2017,18(9):2569.
[22]Leite PM,Tafuri L,Costa MZ,et al.Evaluation of the p16 and Ki-67 biomarkers as predictors of the recurrence of premalignant cervical cancer lesions after LEEP conization[J].Revista Brasileira De Ginecologia E Obstetrícia,2017,39(06):288-293.
[23]Shen K.Selection of treatment methods for cervical intraepithelial neoplasia[J].National Medical Journal of China,2006,85(5):291-294.[沈铿.宫颈上皮内瘤变治疗方法的选择[J].中华医学杂志,2006,85(5):291-294.]
[24]He XM,You ZX.The 2013 WHO guidelines for cervical cancer screening and treatment programmes[J].Progress in Obstetrics and Gynecology,2015,24(3):220-223.[何晓明,尤志学.2013年WHO宫颈癌筛查及处理方案指南的解读[J].现代妇产科进展,2015,24(3):220-223.]
[25]Nam KH,Kwon JY,Kim YH,et al.Pregnancy outcome after cervical conization:risk factors for preterm delivery and the efficacy of prophylactic cerclage[J].J Gynecol Oncol,2010,21(4):225-229.
[26]Zebitay AG,Güng9r ES,Ilhan G,et al.Cervical conization and the risk of preterm birth:A population-based multicentric trial of turkish cohort[J].J Clin Diagn Res,2017,11(3):21-24.
[27]Boulanger JC,Gondry J,Verhoest P,et al.Treatmentof CIN aftermenopause[J].Eur J Obstet Gynecol Reprod Biol,2001,95(2):175-180.
[28]Wang RM,Peng JJ,You ZX.The interpretation of 2012 ASCCPmanagement of abnormal cervical cancer screening tests and cancer precursors(Ⅱ)[J].Journal of International Obstetrics and Gynecology,2015,42(2):238-240.[王荣敏,彭晶晶,尤志学.对ASCCP 2012年宫颈癌筛查和癌前病变管理指南的解读(二)[J].国际妇产科学杂志,2015,42(2):238-240.]
[29]Wongtiraporn W,Laiwejpithaya S.Long term outcomes of laser conization for high grade cervical intraepithelial neoplasia in thai women[J].Asian Pacific Journal of Cancer Prevention,2014,15(18):7757-7761.
[30]Fambrini M,Penna C,Pieralli A.CO2laser cylindrical excision or standard re-conization for persistent-recurrent high-grade cervical intraepithelial neoplasia(HG-CIN)in women of fertile age[J].Anticancer Res,2008,28(6B):3871-3875.
[31]M Arbyn.Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia:Meta-analysis[J].BMJ,2008,337:a1284.
[32]Inaba K,Nagasaka K.High-risk human papillomavirus correlates with recurrence after laser ablation for treatment of patients with cervical intraepithelial neoplasia 3:A long-term follow-up retrospective study[J].J Obstet Gynaecol Res,2014,40(2):554-560.
[33]Bruinsma FJ,Quinn MA.The risk of preterm birth following treatment for precancerous changes in the cervix:A systematic review and meta-analysis[J].BJOG,2011,118(9):1031-1041.
[34]Sauvaget C,Muwonge R,Sankaranarayanan R.Meta-analysis of the effectiveness of cryotherapy in the treatment of cervical intraepithelial neoplasia[J].International Journal of Gynaecology&Obstet,2013,120(3):218-223.
[35]Santesso N,Schünemann H,Blumenthal P,et al.World Health Organization Guidelines:Use of cryotherapy for cervical intraepithelial neoplasia[J].International Journal of Gynecology&Obstetrics,2012,118(2):97-102.
[36]Koizumi K,Fujioka T.Clinical investigation of the safety and efficacy of a cervical intraepithelial neoplasia treatment using a hyperthermia device that uses heat induced by alternating magnetic fields[J].Mol Clin Oncol,2016,5(2):310-316.
[37]Nowak-Stepniowska A,Pergol P,Padzik-Graczyk A.Photodynamic method of cancer diagnosis and therapy-mechanisms and applications[J].Postepy Biochem,2013,59:53-63.
[38]YK Park,CH Park.Clinical efficacy of photodynamic therapy[J].Obstetrics&Gynecology Science,2016,59(6):479.