宫颈锥切术后病理升级为宫颈浸润癌的危险因素分析  

Analysis of risk factors for invasive cervical cancer after leep surgery

作　　者：蔺茹[1] 邵亚雯 傅文婷[1] 李晓玉 郝圆圆 白岩[1] 刘青[1] Lin Ru;Shao Yawen;Fu Wenting;Li Xiaoyu;Hao Yuanyuan;Bai Yan;Liu Qing(GanSu Provincial Maternity and Child Care Hospital,Lanzhou 730050,China)

机构地区：[1]甘肃省妇幼保健院,甘肃兰州730050

出　　处：《甘肃医药》2021年第5期385-388,共4页Gansu Medical Journal

基　　金：兰州市科技计划项目(项目编号:2013-4-93)。

摘　　要：目的:探讨阴道镜下活检为宫颈高级别鳞状上皮内病变(HSIL)患者行宫颈环形电切术(LEEP)术后病理升级为宫颈浸润癌的危险因素。方法:选取2019年1~6月在我院宫颈病变诊疗中心因HSIL行LEEP的608例患者,根据术后病理结果是否为宫颈癌,将入选病例分为病例组54例和对照组554例,对两组患者的年龄、绝经与否、孕次、产次、术前TCT、高危型HPV16/18感染与否、阴道镜诊断、转化区类型、累及象限、术前累及腺体与否、切除标本长度及厚度、切缘状态等临床资料进行相关分析。结果:多因素Logistic回归分显示,年龄>40岁、术前TCT为ASC-H或HSIL或SCC、HPV为16/18+、病灶累及宫颈表面3-4个象限、术前病检累及腺体、标本长度>2.0cm、术后切缘阳性为病理升级的独立危险因素(P<0.05)。结论:对于合并高危因素的患者,术前应充分进行风险评估,在术前沟通、手术方案的选择上要更加慎重,手术医生在进行LEEP手术前,应根据情况适当扩大切除范围,以免漏诊。Objective:To investigate the risk factors of cervical invasive carcinoma after LEEP surgery in patients with cervical HSIL under colposcopy biopsy.Method:Retrospective study was conducted on 608 patients who underwent LEEP surgery for HSIL in the Endoscopy center of GanSu Provincial Maternity and Child Care Hospital from January 2019 to June 2019,According to whether the postoperative pathological results upgraded to cervical cancer,the included patients were divided into 54 cases in the pathological group and 554 cases in the control group,the correlation analysis was carried out on the clinical data of the two groups,including age,menopause,pregnancy,labor,preoperative TCT,HPV16/18 infections,colposcopy diagnosis,TZ,involvement quadrant,preoperative involvement of glands,length and thickness of excised specimens and incisional status.Results:Multivariate Logistic regression analysis found that age of>40 years old,preoperative TCT was ASC-H or HSIL or SCC,HPV was 16/18+,lesions involved 3~4 quadrants of the cervical surface,preoperative involved glands,specimen length>2.0cm,and postoperative positive margins were independent risk factors for pathological upgrade in this study(P<0.05).Conclusions:For patients with the combination of the above risk factors,preoperative risk assessment should be fully carried out,and preoperative communication and selection of surgical plans should be more cautious.Surgeons should give appropriate treatment to expand the resection scope according to the situation before LEEP surgery,so as to avoid missed cervical cancer patients.

关 键 词：高级别鳞状上皮内病变 宫颈环形电切术 宫颈浸润癌 阴道镜 

分 类 号：R737.33[医药卫生—肿瘤]