子宫颈上皮内瘤样病变宫颈环形电切术后切缘阳性病例分析及应对  

Analysis and Management of Cases with Positive Margin of Cervical Intraepithelial Neoplasia after Loop Electrosurgical Excision Procedure

作　　者：鲍春玉 申艳[1] 顾芸[1] BAO Chunyu;SHEN Yan;GU Yun(Nanjing Maternal and Child Health Hospital,Nanjing,Jiangsu 210004,China)

机构地区：[1]南京市妇幼保健院,江苏南京210004

出　　处：《大医生》2020年第11期75-77,共3页Doctor

摘　　要：目的探讨子宫颈上皮内瘤样病变(CIN)宫颈环形电切(LEEP)术后切缘阳性的相关因素及临床处理。方法回顾性分析2016年5月至2018年5月南京市妇幼保健院收治的73例因CIN病变行LEEP术切缘阳性患者,93例切缘阴性患者,对两组患者的年龄、术前宫颈脱落细胞学检查(TCT)、人类乳头瘤病毒(HPV)感染型别、活检病变级别、病变累及颈管及腺体情况、阴道镜特点与子宫颈LEEP术切缘阳性作单因素和多因素分析,并分析不同临床处理的结局。结果患者年龄>40岁、病变累及颈管、累及腺体以及不充分阴道镜检查与切缘阳性有相关性,LEEP术切缘阳性与患者术前TCT、HPV感染型别、活检病变级别无相关性。多因素Logistic分析显示:病变累及颈管、累及腺体以及不充分阴道镜检查是切缘阳性的高度相关因素,相对危险度:7.198、2.388、16.878。切缘阳性患者二次手术病理病灶残留率21/31(67.74%),随访好转率26/33(78.79%)。结论LEEP术后标本切缘阳性主要与年龄>40岁、病变累及腺体及颈管以及不充分阴道镜检查有关。对于切缘阳性患者,应采取个体化治疗。Objective To investigate the related factors and clinical management of positive margins after loop electrosurgical excision procedure(LEEP)for cervical intraepithelial neoplasia(CIN).Methods From May 2016 to May 2018,73 patients with positive margins and 93 patients with negative margins underwent LEEP in Nanjing Maternal and Child Health Care Hospital were retrospectively analyzed.Univariate and multivariate analysis was performed on the age,preoperative TCT,HPV infection type,biopsy lesion grade,cervical duct and gland involvement,colposcopy characteristics and cervical LEEP margin positive.The outcomes of different clinical treatments were analyzed.Results The age of patients over 40 years old,the lesions involving the cervical canal,glands and inadequate colposcopy were correlated with the positive margin,while the positive margin of LEEP was not correlated with the preoperative TCT,HPV infection type and pathological grade of biopsy.Multivariate logistic analysis showed that cervical canal involvement,gland involvement and inadequate colposcopy were highly related factors for positive resection margin,with relative risk of 7.198,2.388,16.878.The residual rate of pathological lesions was 21/31(67.74%),and the improvement rate was 26/33(78.79%).Conclusion The positive margin of LEEP is mainly related to the age of 40 years,the involvement of glands and cervical canal,and inadequate colposcopy.Patients with positive margins should be treated individually.

关 键 词：子宫颈上皮内瘤样病变 子宫颈环形电切术 切缘 

分 类 号：R73[医药卫生—肿瘤]