宫颈上皮内瘤变Ⅲ级锥切术后病变残留相关因素分析  

Study on predictive factors of residual disease in hysterectomy following conization for cervical intraepithelial neoplasia(CIN)Ⅲ

作　　者：李寒松[1] 魏凤华[1] 申桂华[1] 吕秋波[1] 张毅[1] 

机构地区：[1]北京医院妇产科,北京100730

出　　处：《中国医刊》2010年第6期39-42,共4页Chinese Journal of Medicine

摘　　要：目的探讨宫颈锥切术后病变残留的高危因素。方法回顾性分析2002年1月至2009年1月经阴道镜宫颈活检诊断为宫颈上皮内瘤样病变(CIN)Ⅲ级(包括重度不典型增生及原位癌)的患者391例,其中197例直接行全子宫切除术,194例行宫颈冷刀锥切,61例CINⅢ在锥切后半年内行全子宫切除,分析61例患者的年龄、产次、锥切标本切缘、腺体受累、多象限受累等与切除子宫标本中残留病变的关系。结果患者平均年龄为38.6岁(26～63岁),平均产次3.1次。单因素分析结果表明,年龄≥50岁、内切缘阳性、多象限受累是与病变残留有显著关系的因素;绝经状态、产次≥3次、宫颈腺体受累与病变残留无显著关系。多因素logistic回归分析结果表明只有内切缘阳性与多象限受累是病变残留的高危因素。结论内切缘阳性与多象限受累是预测锥切术后病变残留的高危因素。在治疗CINⅢ及其治疗后随访过程中,重视并合理利用高危因素。Objective To determine factors predicting post-cone residual disease in cervical intraepithelial neoplasia （CIN） Ⅲ. Methods Of 391 patients who diagnosed CIN Ⅲ through colposcopy biopsy between January 2002 and January 2009,61 patients underwent hysterectomy within 6 months of conization, were reviewed retrospectively. We analyzed their demographic features and pathologic parameters. Results In univariate analysis, age≥50 years, positive endocervical resection margins, and multiple-quadrant disease were significant factors associated with residual disease. While postmenopausal status, parity ≥ 3, and glandular extension were not significant. In multivariate analysis only positive endocervical margins and multiple-quadrant disease were significant factors associated with residual disease. Conclusion Positive endocervical margins and multiple-quadrant disease were the only significant factors predicating post-cone residual disease in multivariate analysis. Appropriate application of these predictive factors may avoid treatment failure and over-treatment.

关 键 词：宫颈上皮内瘤样病变 原位癌 宫颈早期浸润癌 冷刀锥形切除术 病变残留 

分 类 号：R713.4[医药卫生—妇产科学]