王依妮　何玥　吴玉梅

[摘要] 高危型人乳头瘤病毒（HR-HPV）感染是發生宫颈鳞状上皮内病变（SIL）和宫颈癌发生及发展的必要条件。宫颈高度鳞状上皮内病变（HSIL）及宫颈鳞癌ⅠA1期在锥切术后残留与复发，甚至进展为更严重病变的情况仍然存在。HR-HPV的转归与宫颈病变转归高度相关，HSIL及宫颈鳞癌ⅠA1期行锥切术后的处理及随访应参考HR-HPV监测情况。HR-HPV感染指标在随访中对宫颈病变转归的具体指导意义和影响HR-HPV转归的高危因素仍需深入研究。

[关键词] 高危型人乳头瘤病毒；宫颈高度鳞状上皮内病变；锥切术；转归

[中图分类号] R737.33 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0025-04

Research progress on the prognosis of high-risk human papillomavirus infection after conization of cervical lesions and its related factors

WANG Yini HE Yue WU Yumei

Department of Gynecological Oncology， Beijing Obstetrics and Gynecology Hospital， Capital Medical University， Beijing 100006， China

[Abstract] High-risk human papillomavirus （HR-HPV） infection is a necessary condition in the occurrence and development of cervical squamous intraepithelial lesion （SIL） and cervical cancer. There are cases that high-grade squamous intraepithelial lesion （HSIL） and cervical squamous cancer at stageⅠA1 remain or reoccur， or even become more severe after conization. The prognosis of HR-HPV has high correlation with the prognosis of cervical lesion. The treatment and follow-up of HSIL and cervical squamous cancer at stageⅠA1 after conization should be consulted in the monitoring conditions of HR-HPV. It is worthwhile making further study in the specific practical significance of HR-HPV infection indices for the prognosis of cervical lesion during follow-up， as well as the high-risk factors that influence the prognosis of HR-HPV.

[Key words] High-risk human papillomavirus； High-grade squamous intraepithelial lesion； Conization； Prognosis

目前已公认，高危型人乳头瘤病毒（high risk-human papillomavirus，HR-HPV）感染是发生宫颈鳞状上皮内病变（squamous intraepithelial lesion，SIL）和宫颈癌发生及发展的必要条件[1-2]。中国癌症基金会研究显示，中国城市妇女感染率为15.2%，农村妇女感染率为14.6%。锥切术针对某些宫颈病变诊断的准确性及治愈病变的有效性已达成共识，宫颈高度鳞状上皮内病变（high-grade squamous intraepithelial lesion，HSIL）常规诊疗方式为锥切术[3]，部分年轻且有生育要求的宫颈鳞癌ⅠA1期患者也可考虑锥切术[4]。然而，其彻底清除HR-HPV感染的效果，目前仍存在争议。而且，宫颈病变在CKC术后残留与复发，甚至进展为更严重病变的情况仍然存在。越来越多的研究证实，HR-HPV持续感染在其中发挥着决定性的作用。近年来，伴HR-HPV感染的HSIL和宫颈鳞癌ⅠA1期锥切术后的处理及随访愈发引起关注，HR-HPV感染指标在随访中对宫颈病变转归的指导意义也亟待进一步明确。本文主要探讨了在该类患者术后随访中，监测HR-HPV转归的临床意义、HR-HPV转归情况及影响HR-HPV转归的因素。……