Lara-Peñaranda Rosario, Rodríguez-López Pilar María, Plitt-Stevens Javier, Gómez-Leal Paloma, Remezal-Solano Manuel, Martínez-Cendán Juan Pedro
Department of Medicine, Faculty of Health Sciences, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain.
Deparment of Obstetrics and Gynecology, Hospital Universitario Santa Lucía, Cartagena, Spain.
J Obstet Gynaecol Res. 2020 Oct;46(10):2100-2107. doi: 10.1111/jog.14392. Epub 2020 Jul 19.
The aim of the study was to determine if the depth of large loop excision of the transformation zone (LLETZ) is a risk factor for presenting affected endocervical margins.
A cross-sectional retrospective study was performed on 353 patients that underwent LLETZ after presenting cervical biopsies with CIN grade 2 and grade 3 or persistent CIN grade 1 at Hospital Universitario Santa Lucía, Cartagena, Spain, from November 2011 to December 2016. Automatized measurement of the LLETZ depth was performed in microns and added to cervical canal extensions when these were performed. Other variables studied in positive endocervical margins were age (under or over 35 years), premenopause/postmenopause, number of affected quadrants, CIN grading, the presence of HPV 16 before LLETZ, parity (nulliparous vs multiparous) and the location where the LLETZ was performed (operating room vs consultation room).
Our multivariant analysis showed that LLETZ depth ≤ 10 mm did not increase the risk in affected endocervical margins (P = 0.366) and no statistically significant difference between the two groups (affected and nonaffected margins) was found. CIN grading and parity did prove a statistically significant association (P = 0.039 and P = 0.011, respectively). Age, menopause, number of affected quadrants, HPV 16 and the location did not show statistical association with positive endocervix margins.
LLETZ depth equal to or lower than 10 mm was not proven to be a risk factor to have affected endocervical margins after the treatment. Therefore, higher LLETZ depth would not be justified to ensure oncological results.
本研究旨在确定转化区大环形切除术（LLETZ）的深度是否是宫颈管切缘受累的危险因素。
对2011年11月至2016年12月在西班牙卡塔赫纳圣卢西亚大学医院接受宫颈活检显示为2级和3级宫颈上皮内瘤变（CIN）或持续性1级CIN后行LLETZ的353例患者进行了横断面回顾性研究。以微米为单位对LLETZ深度进行自动测量，若进行了宫颈管扩展术，则将其纳入测量范围。对宫颈管切缘阳性的其他研究变量包括年龄（35岁以下或以上）、绝经前/绝经后、受累象限数、CIN分级、LLETZ术前HPV 16的存在情况、产次（未生育与多产）以及进行LLETZ的地点（手术室与诊室）。
我们的多变量分析显示，LLETZ深度≤10 mm不会增加宫颈管切缘受累的风险（P = 0.366），且两组（受累和未受累切缘）之间未发现统计学上的显著差异。CIN分级和产次确实显示出统计学上的显著关联（分别为P = 0.039和P = 0.011）。年龄、绝经情况、受累象限数、HPV 16以及手术地点与宫颈管切缘阳性均未显示出统计学关联。
LLETZ深度等于或低于10 mm未被证明是治疗后宫颈管切缘受累的危险因素。因此，为确保肿瘤学结果而采用更深的LLETZ深度是不合理的。
