宫颈锥切切缘阳性患者残留或复发高危因素及处理  

High risk factors and management of residue or recurrence in patients with positive margin after cervical conization

作　　者：孟亚萍 石琴 MENG Yaping;SHI Qin(Central Hospital of Jiading District,Shanghai University of Medicine&Health Sciences,Shanghai 201800)

机构地区：[1]上海健康医学院附属嘉定区中心医院,上海201800

出　　处：《陕西医学杂志》2020年第8期983-986,共4页Shaanxi Medical Journal

基　　金：上海市嘉定区科委课题(JDKW-2016-W09)。

摘　　要：目的:分析宫颈锥切切缘阳性患者残留或复发的高危因素,并探讨临床再处理方法。方法:110例宫颈上皮内瘤变Ⅱ(CINⅡ)及以上的高度鳞状上皮内病变(HSIL)患者为研究对象,所有患者均行锥切术治疗,且宫颈切缘为阳性,术后对所有患者进行随访,记录其再次手术及病变残留或复发情况,分析切缘阳性患者的病变残留或复发的高危因素。结果:110例切缘阳性患者中,术后6个月48例患者接受再次手术,其中22例患者发现残留或复发病灶,残留或复发率为45.8%(22/48)。其余62例患者则在初次宫颈锥切术后进行随访,其中17例证实为残余或复发病变,残留或复发率为27.4%(17/62)。初次锥切后病变残留或复发率为35.5%(39/110)。宫颈锥切切缘阳性患者的灶残留或复发率在年龄、产次、是否绝经、病理分级、术后HR-HPV RLU/CO、是否累及腺体、宫颈糜烂程度方面比较,差异均有统计学意义(P<0.05)。年龄、术后HR-HPV RLU/CO(病毒负荷量)值≥300、切缘病理分级是宫颈锥切切缘阳性患者病灶残留或复发的独立危险因素(P<0.05)。结论:切缘阳性与病变残留、复发密切相关,但切缘状态并非行再次手术的唯一指征,需结合患者的年龄、术后HR-HPV及切缘病理分级选择合适的治疗方式,并加强临床随访。Objective:To To analyze the high risk factors of residue or recurrence in patients with positive margin after cervical conization,and to explore the clinical reprocessing methods.Methods:110 cases of high grade squamous intraepithelial lesion(HSIL)with cervical intraepithelial neoplasiaⅡ(CINⅡ)and above was selected as the research objects.All patients were treated with cervical conization,and the cervical margin was positive.All patients were followed up after the operation.The reoperation and the residue or recurrence of the lesions were recorded,and the high-risk factors of the residue or recurrence of the lesions were analyzed.Results:Among the 110 patients with positive margin,48 patients were underwent reoperation at 6 months after surgery,and 22 of them was found residual or recurrent lesions,the residual or recurrence rate was 45.8%(22/48).The remaining 62 patients were followed up after first cervical conization,of which 17 patients were proven to be residual or recurrent lesions,with a residual or recurrence rate of 27.4%(17/62).The total residual/recurrence rate was 35.5%(39/110).There were significant differences in age,number of labor,menopause or not,pathological grading,postoperative HR-HPV RLU/CO,involvement of glands or not and cervical erosion in the rate of residual lesions or recurrence in patients with positive margin after cervical conization(P<0.05).The age,postoperative HR-HPV RLU/CO higher than 300,and pathological grade of margin were independent risk factors for residual or recurrent lesions in patients with positive margin after cervical conization(P<0.05).Conclusion:Positive margin is closely related to residual and recurrent lesions,but the condition of margin is not the only indication for reoperation.It is necessary to select appropriate treatment methods in combination with the patient’s age,postoperative HR-HPV and pathological grade of margin,and strengthen clinical follow-up.

关 键 词：宫颈上皮内瘤变 宫颈锥切术 切缘阳性 残留或复发 高危因素 临床处理 

分 类 号：R711.74[医药卫生—妇产科学]