高级别宫颈上皮内瘤变宫颈锥切术后病灶残留的多因素分析及临床处理探讨  

Analysis of the related residual factors and clinical treatment in the patients receiving cervical conization for high-level cervical intraepithelial neoplasia

作　　者：吴婷婷[1] 李智[1] 李丹军 吴瑞瑾[1] 

机构地区：[1]浙江大学医学院附属妇产科医院妇产科,浙江杭州310006 [2]温岭市第一人民医院妇产科,浙江温岭317500

出　　处：《中国实用妇科与产科杂志》2016年第7期671-675,共5页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨宫颈锥切术后切缘阳性的高级别宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)患者病灶残留的相关因素及其下一步临床处理。方法回顾性分析2007年1月至2014年10月于浙江大学医学院附属妇产科医院行宫颈锥切术切缘阳性并行二次手术的166例高级别CIN患者的临床资料。结果 166例患者二次手术后病理提示炎性改变112例,病灶残留54例,残留率32.5%(54/166)。年龄、绝经状态、初次宫颈锥切宽度及术前高危HPV DNA负荷量为相关因素,其中年龄、初次锥切宽度和术前高危HPV DNA负荷量与病灶残留高度相关。结论术前高危HPV DNA负荷量>1000 RLU/PC,初次锥切体积<1.93 cm3的患者发生病灶残留可能性大,切缘阳性患者有必要行二次手术,手术方式应个体化。Objective To investigate the related residual factors in the patients with high-level cervical intraepithelial neoplasia （CIN） who had positive resection margins after initial conization and the subsequent clinical treatment. Methods A restrospeetive collection of 166 patients＇ clinical data from January 2007 to October 2014 was analyzed. These pa- tients had a second surgery because of the positive resection margin. Results The pathology suggested that there were 112 cases of chronic inflammation and 54 cases of residual lesions, the residual rate being 32.5%（54/166）. Age, meno- pausal status, cone diameter and HR-HPV DNA level were the related factors. Among them, age, cone diameter and HR- HPV DNA load were of high correlation with the residual. Conclusion HR-HPV DNA load 〉 1000 RLU/PC and initial conization volume 〈1.93 cm3 are independent risk factors in patients with residual lesions. Second surgery is necessary for patients with positive resection margins, and the operation method should be individualized.

关 键 词：宫颈上皮内瘤变 宫颈锥切术 切缘阳性 

分 类 号：R711.74[医药卫生—妇产科学]