宫颈锥切术后全子宫切除的CINⅢ患者病灶残留相关因素分析  

Predictive Factors for Residual Disease in Subsequent Hysterectomy Following Conization for CIN Ⅲ

作　　者：吴绪峰[1] 曾蓉[2] 高晗[1] 蔡鸿宁[1] 

机构地区：[1]湖北省妇幼保健院妇瘤科,武汉430070 [2]湖北省肿瘤医院妇瘤科

出　　处：《肿瘤防治研究》2014年第6期614-617,共4页Cancer Research on Prevention and Treatment

基　　金：湖北省卫生厅科研项目资助课题(JX5B33);湖北省医学领军人才培养工程专项经费资助项目

摘　　要：目的 探讨宫颈锥切术后病灶残留的相关因素,为宫颈锥切术后的进一步诊疗提供依据。方法对90例宫颈锥切术后(LEEP术和CKC术)再行全子宫切除的CINⅢ患者进行回顾性分析,探讨患者年龄、HPV感染情况、切缘状态、切缘阳性病变级别以及宫颈锥切方式与病灶残留之间的关系。结果 全部病例治疗后随访42~66月,未发现复发;55例(55/90,61.11%)患者的全宫标本中存在病灶残留;年龄】40岁组(33/47例,70.2%)与≤40岁组(22/43,51.2%)、HPV-H感染组(32/52,61.5%)与HPV-H阴性组(1/2,50.0%)、LEEP术组(49/78,62.8%)与CKC术组(6/12,50.0%)的病灶残留率差异无统计学意义(P】0.05);切缘阳性患者病灶残留率(38/53,71.7%)明显高于切缘阴性患者(17/37,46.0%,P【0.01);切缘病变级别为CINⅡ-Ⅲ患者(27/33,81.8%)病灶残留率明显高于CINⅠ患者(11/20,55.0%,P【0.05)。结论 切缘阳性是CINⅢ病灶残留的危险因素,临床医师可以通过控制切缘阳性从而降低病灶残留,对于切缘阳性患者尤其是切缘高级别病变患者应考虑进一步的治疗及严密的随访。Objective To explore predictive factors for post-cone residual disease in subsequent hysterectomy for cervical intraepithelial neoplasia(CIN)Ⅲ. Methods We determined the relationship between residual disease and clinical features, cone marginal status, CIN grade of positive cone margin, conization type by retrospectively reviewing 90 CINⅢpatients who received hysterectomy following cervix conization. Results All cases were followed up for 42-66 months and no recurrence was found. Residual disease was detected in 55 hysterectomy specimen(55/90, 61.11%). There was no significant difference of residual disease incidence between age >40(33/47, 70.2%) and age ≤40(22/43, 51.2%), HPV-H positive(32/52, 61.5%) and negative(1/2, 50.0%), and LEEP(49/78, 62.8%) and CKC group(6/12, 50.0%)(P>0.05). The residual disease incidence in patients with positive cone margin(38/53, 71.7%)was higher than that with negative cone margin(17/37, 46.0%,P<0.01). The residual disease incidence in patients with cone margin of CINⅡ-Ⅲ(27/33, 81.8%) was higher than that of CINⅠ(11/20, 55.0%,P<0.05). Conclusion Positive cone margin, especially with high CIN grade, is the predictive factor for residual disease in subsequent hysterectomy following conization for CINⅢ and the patients should be attended to further treatment and closely following up. The clinicians could control the cone marginal status to reduce residual disease.

关 键 词：子宫颈上皮内瘤样病变Ⅲ(CINⅢ) 子宫颈锥形切除术 全子宫切除术 病灶残留 

分 类 号：R73[医药卫生—肿瘤]