摘要
目的 探讨宫颈上皮内瘤变(CIN)宫颈锥切术后切缘阴性患者复发或病理升级的危险因素。方法 选择2016年1月—2019年6月本院收治的315例CIN宫颈锥切术后切缘阴性患者作为研究对象。采集子宫颈细胞样本,采用第2代杂交捕获法(HC2)检测高危人乳头瘤病毒(HPV)。术后随访时间为1-2年,记录CIN宫颈锥切术后切缘阴性患者复发/病理升级情况,危险因素采用多因素Logistic回归分析。结果 315例患者术后复发/病理升级的发生率为14.29%。45例患者中随访HPV阳性率为82.22%,共检出5种高危基因型,其中HPV 16检出率最高为72.97%,HPV 58检出率为27.03%,HPV 18检出率为21.62%,HPV 66检出率为13.51%,HPV 45检出率为8.11%,单纯感染25例,双重感染11例,三重感染2例。多因素Logistic回归分析结果显示,绝经、CIN3级、病变累及点位数≥3、病变累及腺体、高危HPV感染是CIN宫颈锥切术后切缘阴性患者复发/病理升级的独立危险因素(P<0.05)。结论 CIN宫颈锥切术后切缘阴性患者可能发生复发或病理升级,其发生风险与绝经、CIN分级、病变累及点位数、病变累及腺体、高危HPV感染等因素有关,临床上应充分考虑上述因素为患者制定合适的治疗方案。
Objective To explore the risk factors of recurrence/pathological upgrade in patients with cervical intraepithelial neoplasia(CIN) of negative margins after cervical conization.Methods 315 CIN patients with negative margins after cervical conization those were admitted to the hospital between January 2016 and June 2019 were collected as study objects. The cervical cell samples were collected,and hybrid capture Ⅱ( HC2) was used to detect high-risk human papillomavirus( HPV). The postoperative follow-up time of patients was 1 to 2years. The recurrence/pathological upgrade was recorded among patients with negative margins after CIN cervical conization,and the risk factors were analyzed by multivariate Logistic regression analysis.Results The incidence rate of postoperative recurrence/pathological upgrade was 14.29% among the 315 patients. Among the 45 patients,the HPV positive rate was 82.22% in follow-up,and 5 high-risk genotypes were identified. And the detection rates of HPV 16,HPV 58,HPV 18,HPV 66 and HPV 45 were 72. 97%( the highest),27. 03%,21. 62%,13.51% and 8. 11%. There were 25 cases of single infection,11 cases of dual infection and 2 cases of triple infection. Multivariate Logistic regression analysis showed that menopause,CIN grade 3,number of lesions involved equal to or over 3,lesions involving glands and high-risk HPV infection were independent risk factors for recurrence/pathological upgrade in patients with negative margins after CIN cervical conization( P < 0. 05).Conclusions Recurrence or pathological upgrade may occur in patients with negative margins after CIN cervical conization. The risk of occurrence is related to menopause,CIN grade,number of lesions involved,lesions involving glands and high-risk HPV infection. It is necessary to fully consider the above factors in clinical practice so as to make appropriate treatment regimens for patients.
作者
张靖博
Zhang Jingbo(The first affiliated hospital of Nanyang Medical College,Nanyang,Henan,473000,China)
出处
《齐齐哈尔医学院学报》
2022年第12期1143-1146,共4页
Journal of Qiqihar Medical University
关键词
宫颈上皮内瘤变
宫颈锥切术
切缘阴性
复发
病理升级
危险因素
Cervical intraepithelial neoplasia
Cervical conization
Negative margins
Recurrence
Pathological upgrade
Risk factors
