宫颈癌子宫切除术后发生阴道鳞状上皮内病变的危险因素分析  

Exploration of influence factors of vaginal squamous intraepithelial lesion after hysterectomy for cervical cancer

作　　者：马蔚蓉[1] 任青玲[1] MA Wei-Rong;REN Qing-Ling(Affiliated Hospital of Nanjing Unwersity of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine,Nanjing,Jiangsu,210029 China)

机构地区：[1]南京中医药大学附属医院江苏省中医院,江苏南京210029

出　　处：《中国妇幼保健》2022年第9期1662-1666,共5页Maternal and Child Health Care of China

基　　金：江苏省卫健委临床医学中心资助项目(YXZXB2016006);江苏省第二周期省妇幼健康重点人才(FRC201711)。

摘　　要：目的探讨子宫颈癌(CC)行子宫切除术后发生阴道鳞状上皮内病变(VaSIL)的因素。方法选取2016年1月—2019年12月于江苏省中医院妇科因CC行子宫切除术后随访的未复发阴道残端癌的患者128例,回顾性分析其临床和病理资料,根据VaSIL发生与否分为VaSIL组和非VaSIL组,分析发生VaSIL的危险因素。结果(1)术后105例(82.03%)转诊阴道镜检查,病理确诊VaSIL 36例(VaHSIL 6例,VaLSIL 30例),VaSIL发病率28.13%,其中VaHSIL发病率4.69%。发病年龄(54.50±7.72)岁,高于未发现病变年龄(50.32±8.81)岁,绝经、免疫相关疾病史及腹腔镜术式的病例术后发生VaSIL的概率升高,差异有统计学意义(P<0.05)。(2)分期ⅠB~ⅡB期、肿瘤大小≥4 cm、阴道壁浸润、宫旁浸润及LVSI阳性,与VaSIL的发病相关,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,LVSI阳性与VaSIL的发生显著相关(P<0.05)。(3)术后高危HPV感染与单一高危HPV的持续感染,与VaSIL的发病相关,差异有统计学意义(P<0.05)。结论CC子宫切除术后需严密随访阴道壁状态,及早筛查VaSIL。年龄、绝经状态、免疫相关疾病史、腹腔镜术式、分期ⅠB~ⅡB、肿瘤大小≥4 cm、阴道壁浸润、宫旁浸润、LVSI阳性、术后高危HPV感染及单一高危HPV持续感染是VaSIL发生的危险因素。Objective To explore the influence factors of vaginal squamous intraepithelial lesion after hysterectomy for cervical cancer(CC).Methods A total of 128 patients with non-recurrent vaginal stump cancer who were followed up after CC hysterectomy in the department of Gynecology of Jiangsu Province Hospital of Chinese Medicine from January 2016 to December 2019 were selected for a retrospective analysis of their clinical and pathological data.According to the occurrence of VaSIL,they were divided into the VaSIL group and the non-VaSIL group, and the risk factors of VaSIL were analyzed.Results(1)105 cases(82.03%) were referred to colposcopy after surgery, and 36 cases of VaSILs were pathologically confirmed(6 cases of VaHSILs, 30 cases of VaLSILs),with the incidence of VaSIL28.13% and VaHSIL4.69%.The age at onset(54.50±7.72)years old was higher than the age(50.32±8.81)years old at which no lesion was found.Cases of menopause, immune related diseases history, and laparoscopic operation, had increased risks of postoperative VaSIL,differences were statistically significant(P<0.05).(2)Factors of stageⅠB~ⅡB,tumor size 4 cm or more, vaginal wall infiltration, parauterine infiltration, and positive LVSI were contributed to VaSIL,the differences had statistical significance(P<0.05).MultivariateBinary Logistic regression analysis showed that positive LVSI was significantly correlated with the occurrence of VaSIL(P<0.05).(3)Factors of high risk HPV infection, and single high-risk HPV persistent infection were contributed to VaSIL after hysterectomy, the differences had statistical significance(P<0.05).Conclusion After CC hysterectomy, vaginal wall status should be closely followed up and VaSIL should be screened as soon as possible.Age, menopausal status, immune related diseases history, laparoscopic operation, stageⅠB~ⅡB,tumor size 4 cm or more, vaginal wall invasion, paracyclic invasion, positive LVSI,postoperative high-risk HPV infection and single high-risk HPV persistent infection were the risk factors for VaSIL.

关 键 词：阴道鳞状上皮内病变 子宫切除术后 子宫颈癌 危险因素 

分 类 号：R737.33[医药卫生—肿瘤]