宫颈HSIL行锥切术后病灶残留的高危因素及子宫切除时机探讨  

Analyze the Risk Factors of Residual Lesions after Conization of Cervical High-grade Squamous Intraepithelial Lesions and to Explore the Time of Hysterectomy

作　　者：王三锋[1] 胡克[1] 钟沅月 麦碧[1] 何裕[1] 张煦[1] 黎玉涵 WANG San-feng;HU Ke;ZHONG Yuan-yue;MAI Bi;HE Yu;ZHANG Xu;LI Yu-han(Guangdong Women and Children′s Hospital, Guangzhou 511400, China)

机构地区：[1]广东省妇幼保健院妇科

出　　处：《中国医药指南》2019年第17期3-4,6,共3页Guide of China Medicine

基　　金：广东省科技计划项目(2017ZC0285);广东省中医药局面上项目(20171029)

摘　　要：目的探讨宫颈高级别鳞状上皮内病变行宫颈锥切锥切术后病变残留的危险因素及子宫切除术的时机。方法收集2015年1月至2017年12月在广东省妇幼保健院因宫颈高级别鳞状上皮内病变行宫颈锥切后再行子宫切除患者的临床资料;统计子宫切除前后病理结果、术后半年及术后1年HPV转阴情况;分析年龄、HPV类型、宫颈转化区类型、切缘状态、宫颈补切状态对病变残留的影响。结果107例子宫切除中(切缘阳性64例,切缘阴性43例),切缘阴性病变残留(27.91%),切缘阳性病变残留率(50.00%),差异有统计学意义(P=0.0378)。术后病理升级3例,均为宫颈癌IA1期。多因素分析显示宫颈切缘阳性是病变残留的高危因素[OR=2.469(95%CI1.05~5.83)],年龄、HPV类型、转化区类型、宫颈管补切状态对病变残留的影响差异无统计学意义。结论切缘阳性是宫颈HSIL锥切术后病变残留的高危因素;子宫切除术应在宫颈锥切术后石蜡病理确诊后进行。Objective To analyze the risk factors of residual lesions after conization of cervical high-grade squamous intraepithelial lesions and to explore the time of hysterectomy. Methods The clinical data of patients undergoing hysterectomy after conization of cervix due to cervical high-grade squamous intraepithelial lesions in Guangdong Women and Children Hospital from January 2015 to December 2017 was collected. The pathological manifestations before and after hysterectomy were compared and the regression condition of HPV 6 months and 1 year after hysterectomy was recorded. The effects of age, HPV type ,cervical transformation zone type, incision margin state and endocervical incision state on the residual disease were analyzed. Result Among the 107 cases performed with hysterectomy (64 cases with positive resection margin, 43 cases with negative resection margin), the incidence rate of residual lesions in positive resection margin group (27.91%) and negative resection margin group (50.00%) had significant difference (P =0.0378). Postoperative pathological upgrading occurred in 3 cases, all of which were found to be stage IA1 cervical cancer. The multivariate analysis showed that positive margin of cervical incision was a high risk factor for residual disease [OR=2.469 (95% CI 1.05-5.83)]. There was no significant difference on residual disease in groups of age, HPV type, type of transformation zone and endocervical incision state. Conclusion Positive resection margin is a high risk factor for the occurrence of residual lesions after HSIL conization. Pathological examination of the cervical conization samples should be performed before hysterectomy.

关 键 词：宫颈鳞状上皮内病变 子宫切除术 宫颈锥切术 病变残留 危险因素 

分 类 号：R737.33[医药卫生—肿瘤]