宫颈上皮内瘤变Ⅲ级术后切缘阳性影响因素及预后分析  

Analysis of the influencing factors and prognosis of cervical intraepithelial neoplasia gradeⅢwith positive margin after surgery

作　　者：孙云 徐郑军[1] 肖红[1] 李景林 SUN Yun;XU Zhengjun;XIAO Hong;LI Jinglin(Department of Gynecology,Fuyang People′s Hospital,Anhui Fuyang 236000,China;Department of Pathology,Fuyang People′s Hospital,Anhui Fuyang 236000,China)

机构地区：[1]阜阳市人民医院妇科,安徽阜阳236000 [2]阜阳市人民医院病理科,安徽阜阳236000

出　　处：《中国妇幼健康研究》2021年第10期1410-1414,共5页Chinese Journal of Woman and Child Health Research

基　　金：安徽省自然科学基金资助项目(1708085MH184)。

摘　　要：目的探讨宫颈上皮内瘤变Ⅲ级术后切缘阳性的影响因素及预后情况。方法选取2017年2月至2019年10月在阜阳市人民医院行宫颈环形电切除术(LEEP)治疗的395例宫颈上皮内瘤变Ⅲ级患者为研究对象,统计患者的组织标本切缘情况,比较切缘阳性组与切缘阴性组临床资料,采用Logistic回归分析影响宫颈上皮内瘤变Ⅲ级患者术后切缘阳性的影响因素。所有患者术后随访1年,比较切缘阳性组与切缘阴性组患者的预后情况。结果395例CINⅢ级患者中切缘阳性患者为67例,切缘阳性率为16.96%。切缘阳性组患者的性生活开始年龄显著低于切缘阴性组(t=2.389,P<0.05),而孕次显著高于切缘阴性组(t=2.409,P<0.05)。切缘阳性组患者吸烟、已绝经、高危型HPV感染、累及腺体、中/重度宫颈糜烂的构成比均显著高于切缘阴性组(χ^(2)值分别为35.813、5.355、15.527、5.009、6.461,P<0.05)。Logistic多因素回归分析结果显示高危型HPV感染、累及腺体、中/重度宫颈糜烂均是CINⅢ级患者术后切缘阳性的危险因素(OR值分别为3.700、4.108、3.508,P<0.05)。随访1年结束后,切缘阳性组复发率为43.75%(28/64),切缘阴性组复发率为10.28%(33/321),两组复发率比较差异有统计学意义(χ^(2)=6.052,P<0.05)。结论高危型HPV感染、累及腺体、中/重度宫颈糜烂是CINⅢ级患者术后切缘阳性的危险因素,且切缘阳性患者术后复发率高于切缘阴性患者,临床上应加强对锥切术后切缘阳性患者进行随访。Objective To explore the influencing factors and prognosis of cervical intraepithelial neoplasia(CIN)gradeⅢwith positive margin after surgery.Methods A total of 395 patients with CIN gradeⅢwho received loop electrosurgical excision procedure(LEEP)treatment in Fuyang People′s Hospital from February 2017 to October 2019 were selected as the research subjects.The resection margins of the tissue specimens of the patients were counted,the clinical data of the positive resection margin group and the negative resection margin group were compared.Logistic regression was used to analyze the influencing factors of CIN gradeⅢpatients with positive margins after surgery.All patients were followed up for 1 year after surgery,and the prognosis of patients in the positive margin group and the negative margin group was compared.Results Among the 395 CIN gradeⅢpatients,67 patients had positive margins,with a positive margin rate of 16.96%.The age of sexual initiation in the positive margin group was significantly lower than that in the negative margin group(t=2.389,P<0.05),while the gravidity in the positive margin group was significantly higher than that in the negative margin group(t=2.409,P<0.05).The proportions of smoking,menopausal,high-risk HPV infection,gland involvement,and moderate/severe cervical erosion in the positive margin group were significantly higher than those in the negative margin group(χ^(2)=35.813,5.355,15.527,5.009 and 6.461,respectively,P<0.05).Logistic multivariate regression analysis showed that high-risk HPV infection,gland involvement,and moderate/severe cervical erosion were all risk factors for positive margin in CIN gradeⅢpatients after surgery(OR=3.700,4.108 and 3.508,respectively,P<0.05).At 1 year of follow-up,the recurrence rate of the positive margin group was 43.75%(28/64),and the recurrence rate of the negative margin group was 10.28%(33/321).The difference in recurrence rate between the two groups was statistically significant(χ^(2)=6.052,P<0.05).Conclusion High-risk HPV infect

关 键 词：宫颈上皮内瘤变 宫颈上皮内瘤变Ⅲ级 切缘阳性 影响因素 预后 

分 类 号：R737.33[医药卫生—肿瘤]