Analysis of fertility preservation and HPV negative conversion rate of LEEP by separating the vesicorectal space
10.3969/j.issn.1672-8467.2024.02.010
- VernacularTitle:经阴道分离膀胱直肠间隙的宫颈LEEP术后HPV转阴情况及生育能力分析
- Author:
Ting JIANG
1
;
Yu XIE
;
Ying-Xin GONG
;
Yun-Qiang ZHANG
;
Yue SHI
;
Ruo-Yi GUO
;
Qing WANG
;
Xiao-Xia LIU
Author Information
1. 复旦大学附属妇产科医院妇科 上海 200011;上海市女性生殖内分泌相关疾病重点实验室 上海 200011;复旦大学附属妇产科医院长三角一体化示范区青浦分院妇科 上海 201713
- Keywords:
human papillomavirus(HPV);
fertility preservation;
high-grade cervical intraepithelial neoplasia(HSIL);
loop electrosurgical excision procedure(LEEP)
- From:
Fudan University Journal of Medical Sciences
2024;51(2):211-217
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the eradication rate of human papillomavirus(HPV)and gestational outcome of patients with high-grade squamous intraepithelial disease of the cervix(HSIL)after loop electrosurgical excision procedure(LEEP)by transvaginal dissection of the vesicorectal form the cervix.Methods A total of 53 patients treated with LEEP by transvaginal dissection of the vesicorectal form the cervix in Obstetrics and Gynecology Hospital,Fudan University from Jan to Dec,2019 were investigated.Clinical information of cervical cytological examination,HPV test and cervical biopsy under colposcopy were followed up for 6,12 and 24 months post-LEEP were collected.HPV infection in these 53 patients were compared before and after LEEP surgery.The rate of successful fertility of the cohort,the HPV conversion rate of patients with hysterectomy and LEEP done were compared.The association between the pathological type and positive surgical margin and the association between HPV infection type and positive surgical margin were analyzed.Results HPV infection rate of was 94.3%(50/53)and the proportion of HPV16 and/or 18 infection was 75.5%(40/53).Mono-HPV infection rate(69.8%,37/53)was significantly higher than mixed HPV infection rate(22.7%,13/53).Thirty-eight patients(71.7%)were found with positive surgical margin in previous LEEP operation.Fifteen patients had recurrence(28.3%)and 40 patients(75.5%)successfully delivered baby after surgery.Postoperative pathology was mainly HSIL,accounting for 66%(30/53),and 28.3%patients(15/53)had no pathological change.Forty cases had satisfying fertility-conservative operation outcome with negative surgical margin,and 38 patients eradicated HPV infection after LEEP,which took up 95%of patients with satisfying fertility-conservative operation.There was no significant difference of positive resection margin rate in between groups of HPV16/18 infection and other types.Five cases had successful delivery(12.5%,5/40)with 1 case of vaginal delivery and 4 cases of cesarean section.Among these 5 cases,3 cases undertook preventive cervical cerclage,with 1 case of vaginal delivery and 2 cases of cesarean sections.Conclusion HPV eradication rate and surgical outcome could be significantly improved by LEEP with transvaginal dissection of the vesicorectal from the cervix,which satisfied the fertility preservation of females at reproductive age.
