摘要
目的宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）是与宫颈浸润癌密切相关的一组癌前期病变。宫颈锥切术已成为CIN患者首选的治疗方法，手术病理切缘阳性是宫颈锥切术后病变复发的危险因素。本研究通过对接受宫颈冷刀锥切术（coldknifecone，CKC）或环形电切除术（loop electrosurgical excision procedure，LEEP）的CIN患者进行回顾性分析，探讨造成宫颈锥切术切缘阳性的原因，旨在降低切缘阳性率。方法回顾性分析沈阳市妇婴医院2013-0101—2014-12-31经阴道镜宫颈活检诊断为CIN并接受宫颈锥切术471例患者，对患者年龄、是否绝经、HPV感染、病变范围、手术方式、病变级别和术后病理提示宫颈上皮腺体受累等7种因素与宫颈锥切术后切缘阳性率做相关性分析。结果471例宫颈锥切术患者中63例术后病理提示切缘阳性，阳性率为13．38％。单因素分析结果显示，宫颈锥切术后切缘阳性与HPV感染（x2=8．470，P〈0．05）、手术方式（x=8．851，P〈0．01）、病变级别（x2=9．842，P〈0．05）及宫颈上皮腺体受累（x2=3．560，P〈0．05）有关，与患者年龄（t=1．293，P〉0．05）、是否绝经（x.=0．204，P〉0．05）及病变范围（x2=0．498，P〉0．05）无关。多因素Logistic回归分析显示，HPV感染、LEEP和宫颈高级别病变是CIN锥切术后切缘阳性的危险因素。其中HPV感染因素，与HPV阴性组比较，HPV低危和高危组0R值分别为2．611（95％CI为1．214～5．615）和2．338（95％CI为1．100～4．968）；病变级别因素，与CINI比较，CINⅡ、CINⅢ和早期宫颈癌组0R值分别为7．903（95％CI为1．046～29．725）、27．852（95％CI为4．131～86．835）和21．548（95％CI为1．373～124．877）。结论HPV感染、LEEP及CIN高级别病变是造成宫颈锥切术切缘阳性的高危因素，在CIN制定宫颈锥切手术方式时应予以重视。
OBJECTIVE Cervical intraepithelial neoplasia is a set of precancerous lesions which is closely related with invasive carcinoma of cervix uteri. Conization of cervix has been the first choice of patients who develop the disease of cervical intraepithetial neoplasia. The positive margin of conization is the hazards of the recrudescence after the conization. This research is a retrospective analysis of patients who were diagnosed as cervical intraepithelial neoplasia （CIN） and accepted the surgery of cold knife cone （CKC） or loop electrosurgical excision procedure（LEEP）, in which the reasons of the positive margin of conization were discussed. METHODS A retrospective analysis of 471 cases of patients who were diagnosed as CIN by colposcopy cervical biopsy and accepted the conization in Shenyang women＇s and children＇s hospital was presented. The relationship between the positive margin of conization and clinical pragnostic factors, such as patients age, menopause, the extent of the lesion,human papillomavirus （HPV） infection, the procedure of excision, disease grade and cervical epithelial gland involvement were analyzed. RESULTS The rate of the positive margin in 471 patients was 13.38%（63/471）. Single factor analysis showed that HPV infection （Z2 =8. 470, P〈0.05）, the procedure of excision （x2 =8. 851, P%0.01）, disease grade （X2 =9. 842, P〈0.05） and cervical epithelial gland involvement （x2 =3. 560, P% 0.05）were correlation with positive margin, but patients age （t=1. 293, P：〉0.05）, menopause （x2 =0. 204, P〉0.05） and the extent of the lesion （2 =0. 498, P〉0.05） were not. The logistic regression analysis showed that HPV infection, LEEP and high-level lesions of CIN were high risk factors associated with the positive margin. Compared with HPV negative group, the OR （95%CI） of low risk and high risk HPV infection were 2. 611（1. 214-5. 615） and 2. 338 （1. 100-4. 968）. Compared with the group of CIN I , the OR （95%CI） of CINⅡ , CINⅢ and
出处
《中华肿瘤防治杂志》
CAS
北大核心
2016年第4期262-265,共4页
Chinese Journal of Cancer Prevention and Treatment
基金
沈阳市科技计划(F15-139-9-11)
