摘要
目的探讨影响CINⅢ级患者宫颈锥切术后切缘阳性及术后HPV转阴的相关因素,以期为CINⅢ级患者进行个体化治疗提供指导依据。方法回顾性分析2010年1月~2015年12月因宫颈活检提示CINⅢ级行宫颈冷刀锥切术的患者734例的临床资料及术后随访资料,观察指标包括:年龄、HPV感染情况、腺体累及情况、绝经状态、阴道镜检查、孕次、产次、教育背景、经济背景、锥切深度、锥切宽度、主诉症状、主诉症状持续时间、切缘状态及术后HPV感染情况。结果 734例CINⅢ级患者行宫颈冷刀锥切术后切缘阳性率26.02%,单因素分析结果显示病变累及宫颈腺体与术后切缘阳性有统计学意义(x2=4.221,P=0.040)。Logistic回归分析结果显示锥切术后6个月HPV转阴率与年龄、绝经状态、切缘状态有关,而与经济背景、文化背景、症状、症状持续时间、HPV感染数目、孕产次、锥切深度、术前阴道镜检查、腺体累及与否均无明显关系,并认为年龄≤40岁、未绝经及术后切缘阴性是影响锥切术后HPV转阴的保护因素。结论病变累及腺体是CINⅢ级宫颈锥切术后切缘阳性的独立危险因素。年龄≤40岁、未绝经状态、切缘阴性是CINⅢ级锥切术后HPV转阴的保护因素。
Objective To investigate the influencing factors of positive margin and human papillomavirus（ HPV） turning negative of cervical intraepithelial neoplasia Ⅲ（ CINⅢ） after conization,so as to provide guidance for the individualized treatment of patients with CINⅢ.Methods The clinical data and postoperative follow-up data of 734 patients with CINⅢ which had pathological diagnosis by cervical biopsy underwent cold knife conization from 2010 to 2015 were analyzed retrospectively. The main observation indexes included age,HPV infection,gland involvement,menopausal status and colposcopy,pregnancy,parity,educational background,economic background,conization depth,conization width,chief complaint symptoms,duration of chief complaint symptoms,margin status and postoperative HPV infection. Results The positive rate of margin after cold knife conization was 26.02% in 734 CINⅢ patients. Univariate analysis showed that the cervical gland involvement and margin positive were statistically significant（ x2= 4.221,P = 0.040）. Logistic regression analysis showed that the negative conversion rate of HPV 6 months after conization was related to age,menopausal status and margin status,but not to economic background,cultural background,symptoms,duration of symptoms,number of HPV infection,pregnant and parturient times,conization depth,preoperative colposcopy,gland involvement or not. The protective factors for HPV negative after conization were age of 40 years or younger,non-menopause and negative postoperative margins. Conclusion The involvement of glands is an independent risk factor for positive margins of CINⅢ after conization. Age of 40 yeurs or younger,non-menopausal status and negative margins were protective factors for HPV negative after conization.
作者
张玮
邓秦潇
彭丽秀
Zhang Wei;Deng Qinxiao;Peng Lixiu(Chenzhou No.1 People＇s Hospital,Chenzhou,Hunan 423000,China)
出处
《湘南学院学报（医学版）》
2018年第3期5-10,共6页
Journal of Xiangnan University（Medical Sciences）
关键词
宫颈上皮内瘤变Ⅲ级
宫颈锥切术
人乳头瘤病毒
cervical intraepithelial neoplasia Ⅲ
cervical conization
human papillomavirus
