摘要
目的探讨影响宫颈上皮内瘤变Ⅲ（cervical intraepithelial neoplasiaⅢ,CINⅢ）锥切病理切缘阳性的高危因素及进一步处理的选择。方法回顾性分析我院2004年1月~2010年4月442例因CINⅢ住院行冷刀锥切的临床资料,其中术后病理切缘阳性41例（切缘阳性组）,切缘阴性401例（切缘阴性组）。结果多因素分析显示切缘阳性与宫颈重度糜烂（OR=3.438,95%CI=1.323~8.933）,原位癌（OR=3.792,95%CI=1.594~9.022）,病变累及腺体（OR=3.940,95%CI=1.724~9.004）,病变点数〉3个（OR=5.083,95%CI=2.192~11.787）相关。切缘阳性组21例接受了再次手术,残留病灶发生率38.1%（8/21）,与切缘阴性组14.8%（8/54）无统计学差异（Z=1.898,P=0.058）。切缘阳性组20例接受随访,病变持续存在或复发率为15.0%（3/20）,显著高于切缘阴性组1.7%（3/241）（Z=2.799,P=0.005）。结论病变点数〉3个、病变累及腺体、原位癌、病变大小（宫颈糜烂外观）是CINⅢ切缘阳性的高危因素。切缘阳性与病变复发/持续有关。如果再次锥切不可能时,切缘阳性的患者可行子宫全切术,对于要求保留生育功能的患者应严密随访。
Objective To assess the high-risk factors associated with conization margin status and management options in patients with cervical intraepithelial neoplasia Ⅲ（CIN Ⅲ）. Methods A retrospective analysis on 442 patients with CIN Ⅲ who underwent conization between January 2004 and April 2010 in our hospital.Postoperative pathological analysis showed positive surgical margin in 41 cases（positive group）,and negative margin in the other 401 cases（negative group）. Results Binary logistic analysis showed that positive margin is correlated with severe cervical erosion（OR=3.438,95%CI=1.323-8.933）,in situ carcinoma（OR=3.792,95%CI=1.594-9.022）,involvement of the glands（OR=3.940,95%CI=1.724-9.004）,and 3 lesions（OR=5.083,95%CI=2.192-11.787）.In our patients,the 21 cases of positive margin received a second surgery,after which the rate of residual lesion was 38.1%（8/21）,which was similar to that in the negative group（14.8%,8/54;Z=1.898,P=0.058）.A follow-up was achieved in 20 of the 21 positive patients,during the follow-up,3 patients showed recurrence or persisitence of the lesion（15.0%）;the rate was significantly higher than that in the negative group（1.7%,3/241,Z=2.799,P=0.005）.Conclusions More than 3 lesions,glands involvement,in situ carcinoma,and cervical erosion are high-risk factors of positive surgical margin in patients with CIN Ⅲ.The positive margin is associated with recurrence/persistence.If re-conization is technically impossible,simple hysterectomy is the treatment option for the patients with positive margins.The patients with CIN Ⅲ should be followed up closely,especially for those with positive margins.
出处
《中国微创外科杂志》
CSCD
2011年第3期196-199,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
宫颈上皮内瘤变Ⅲ
宫颈锥切
切缘阳性
Cervical intraepithelial neoplasia Ⅲ
Conization
Positive margin
