年龄≥50岁患者子宫颈锥切术后高级别及以上病变残留的高危因素分析  

Risk factors for high-grade cervical intraepithelial lesion and above residual lesions after cervical conization in patients more than 50 years old

作　　者：张岱[1] 徐子杰 米兰[1] 毕蕙[1] ZHANG Dai;XU Zijie;MI Lan;BI Hui(Department of Obstetrics and Gynecology,First Hospital of Peking University,Beijing 100034,China)

机构地区：[1]北京大学第一医院妇产科,100034 [2]北京市朝阳区妇幼保健院

出　　处：《中国妇产科临床杂志》2021年第4期344-347,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨年龄≥50岁患者子宫颈锥切术后子宫颈高级别(high grade cervical intraepithelial lesion,HSIL)及以上病变(HSIL+)残留的高危因素。方法回顾性分析2013年1月至2019年12月在北京大学第一医院年龄≥50岁行子宫颈锥切术的395例患者的临床资料,分析其子宫颈锥切术后HSIL+病变残留的高危因素。结果395例患者锥切术后HSIL残留39例(9.87%, 39/395)。单因素分析发现,细胞学高级别异常(P=0.008)、阴道镜印象HSIL(P=0.000)、基于筛查及阴道镜印象评估的高风险(P=0.000)、锥切后病理结果 HSIL(P=0.000)、切缘阳性(P=0.000)、锥切术后ECC阳性(P=0.000)对锥切术后HSIL+病变残留的评估有统计学意义;多因素回归分析发现,仅锥切术后ECC阳性是子宫颈锥切术后HSIL+病变残留风险的独立危险因素(OR=16.571, 95%CI:5.208~52.732)。结论年龄≥50岁女性宫颈锥切术后HSIL+病变残留的风险较高,锥切术后ECC阳性的患者是重点关注人群,应加强这部分女性锥切术后的管理。Objective To investigate the risk factor of high-grade cervical intraepithelial lesion and above(HSIL+)residual disease in women ≥ 50 years after conization. Methods The clinical data of 395 patients with age ≥ 50 years old who underwent cervical conization in First Hospital of Peking University from January 2013 to December 2019 were retrospectively analyzed, and high risk factors for high grade cervical intraepithelial lesion and residual disease post conization were analyzed. Results The risk of residual HSIL+ in patient with age ≥ 50 years old was 9.87%(39/395). Univariate analysis found that pap smear abnormality(P = 0.008), colposcopy impressions(P = 0.000), risk assessment based on screening and colposcopy impressions(P = 0.000), pathological results after conization(P = 0.000), margin status(P = 0.000), ECC post conization(P = 0.000) were the predictors for HSIL+ post conization, there was statistically difference. Multivariate regression analysis showed that the positive ECC after conization was an independent risk factor for the residual risk of HSIL +(OR = 16.571, 95%CI: 5.208 ~ 52.732). Conclusion The risk of residual HSIL+ after conization is high in patient with age ≥ 50 years old, especially in ECC positive patients after conization, the management of these women after conization should be strengthened.

关 键 词：高龄女性 子宫颈锥切术 宫颈管搔刮术 宫颈上皮内病变 病变残留 

分 类 号：R737.33[医药卫生—肿瘤]