宫颈上皮内瘤变3级锥切边缘阳性与锥切后病变残留的危险因素分析  

Risk factor analyses of positive margins of conization specimen and post-cone residual disease in patients with cervical intraepithelial neoplasia grade 3

作　　者：杨洋[1] 游可理[1] 陈翠莹[1] 李志刚[2] 

机构地区：[1]南方医科大学研究生院,广州医学硕士研究生510515 [2]广东省人民医院妇产科,广州510080

出　　处：《医学研究生学报》2015年第6期613-617,共5页Journal of Medical Postgraduates

摘　　要：目的宫颈上皮内瘤变3级（cervical intraepithelial neoplasia grade 3,CIN3）锥切边缘阳性是宫颈病变持续或进展为早期浸润癌的高危因素。文中旨在探讨CIN3锥切边缘阳性与锥切后全宫切除标本中病变残留的危险因素。方法回顾性分析广东省人民医院2001至2013年218例先行锥切后再行全宫切除术CIN3患者的临床资料,采用多因素logistic回归分析筛选锥切边缘阳性与锥切后病变残留的独立危险因素。结果患者中55例（25.2%）锥切标本边缘阳性,锥切边缘阳性的独立高危因素是阴道镜检查满意度（OR：5.18,95%CI：2.49～11.10）、锥切标本横径（OR：7.68,95%CI：2.31～28.10）以及CIN3（OR：4.38,95%CI：1.67～12.10）。患者中锥切后全宫切除标本中有病变残留47例（21.6%）,病变残留的独立高危因素是锥切标本长径（OR：2.45,95%CI：1.12～5.69）、CIN3（OR：4.96,95%CI：2.17～11.70）及锥切标本边缘状态（OR：4.34,95%CI：1.95～9.78）。结论阴道镜检查满意度、锥切标本径线（横径、长径）、原位癌及锥切标本边缘状态可引起CIN3患者锥切边缘阳性或病变残留,临床工作中需高度重视。Objective Positive margins of conization specimen for cervical intraepithelial neoplasia grade（ CIN） 3 is a high risk factor of continuous cervical lesions or progress to early invasive carcinoma. The aim of this study was to evaluate the risk factors of positive margins of conization specimen and post-cone residual disease in hysterectomy specimens following conization for CIN3.Methods Clinical data from 218 patients with CIN 3 underwent hysterectomy after conization from 2001 to 2013 were analyzed retrospectivly. Multi-factors logistic regression was performed to determine the independent risk factors for positive margins of conization specimen and post-cone residual disease. Results Fifty five cases（ 25. 2%） had positive margin of conization specimen,and the independent risk factors were unsatisfactory colposcopy（ OR： 5. 18,95% CI： 2. 49- 11. 10）,width of conization specimen smaller than2 cm（ OR： 7. 68,95% CI： 2. 31- 28. 10） and pathology of CIN3 with carcinoma in situ（ OR： 4. 38,95% CI： 1. 67- 12. 10）. Forty seven patients（ 21. 6%） had post-cone residual disease,and the independent risk factors were length of conization specimen smaller than 1. 5cm（ OR： 2. 45,95% CI： 1. 12- 5. 69）,pathology of CIN3 with carcinoma in situ（ OR： 4. 96,95% CI： 2. 17- 11. 70） and status of conization margins（ OR： 4. 34,95% CI： 1. 95- 9. 78）. Conclusion The satisfaction of colposcopic examination,conization specimen diameters including width and length,CIN3 with carcinoma in situ and status of conization margins could contribute to positive margins of conization or residual disease in subsequent hysterectomy specimens. More attention should be paid to such a group of CIN3 patients clinically.

关 键 词：宫颈上皮内瘤变3级 宫颈锥切 边缘阳性 全宫切除术 病变残留 

分 类 号：R737.33[医药卫生—肿瘤]