阴道镜引导下子宫颈管搔刮术后诊断的CINⅠ患者中存在CINⅡ^(+)的风险因素及分层研究  

Stratified research on related risk factors of CINⅡ^(+)in CINⅠpatients diagnosed by endocervical curettage under colposcopy

作　　者：肖晶晶[1] 陈子任 汪清[1] 隋龙[1] 丛青[1] Xiao Jingjing;Chen Ziren;Wang Qing;Sui Long;Cong Qing(Cervical Disease Center,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院宫颈与阴道早期疾病诊治中心,上海200011

出　　处：《中华妇产科杂志》2022年第8期608-617,共10页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨阴道镜引导下子宫颈管搔刮术(ECC)后诊断的子宫颈上皮内瘤变(CIN)Ⅰ患者中存在CINⅡ及以上病变(CINⅡ^(+))的相关风险因素,并进行风险分层研究。方法(1)回顾性分析2013年1月至2021年6月复旦大学附属妇产科医院在阴道镜引导下诊断的CINⅠ(包括ECC诊断和点活检诊断)并进一步行子宫颈环形电切术(LEEP)患者的临床资料。患者分为两组,ECC CINⅠ组:LEEP术前3个月内行ECC后诊断的CINⅠ患者,且子宫颈点活检术后诊断≤CINⅠ;点活检CINⅠ组:LEEP术前3个月内行子宫颈点活检术后诊断的CINⅠ患者,且ECC阴性(指ECC术后病理诊断为正常子宫颈管)。对两组CINⅠ患者的LEEP术前临床资料及LEEP术后CINⅡ^(+)的检出率进行比较。(2)对阴道镜引导下诊断的CINⅠ患者LEEP术后病理升级为CINⅡ^(+)的相关影响因素进行分析,单因素分析采用χ^(2)检验,多因素分析采用logistic回归法。(3)对LEEP术后病理升级为CINⅡ^(+)的风险因素进行分层分析。结果(1)本研究纳入阴道镜引导下诊断的CINⅠ并进一步行LEEP的患者共2581例,其年龄为(43.6±9.5)岁;其中ECC CINⅠ组957例,点活检CINⅠ组1624例。两组患者的年龄、细胞学结果分别比较,差异均有统计学意义(P均<0.05);而两组患者的高危型人乳头状瘤病毒(HR-HPV)检测、转化区(TZ)类型和阴道镜印象分别比较,差异则均无统计学意义(P均>0.05)。ECC CINⅠ组LEEP术后病理升级为CINⅡ^(+)者288例(30.1%,288/957),点活检CINⅠ组333例(20.5%,333/1624),两组比较,差异有统计学意义(χ^(2)=30.31,P<0.001)。(2)2581例CINⅠ患者中,LEEP术后病理诊断为≤CINⅠ1960例、CINⅡ^(+)621例。单因素分析显示,两者的细胞学检查、ECC术后诊断、TZ类型分别比较,差异均有统计学意义(P均<0.001);而两者的年龄、HR-HPV检测、阴道镜印象分别比较,差异则均无统计学意义(P均>0.05)。多因素logistic回归分析显示,细胞学结果为不�Objective To estimate risks of cervical intraepithelial neoplasia(CIN)Ⅱor worse(CINⅡ^(+))on loop electrosurgical excisional procedure(LEEP)specimens with the diagnosis of endocervical curettage(ECC)CINⅠcompared with biopsy CINⅠ,and also to investigate the hierarchical management scheme of ECC CINⅠbased on the relevant factors of CINⅡ^(+)risk.Methods(1)A retrospective computer-based research for subjects enrolled in the Obstetrics and Gynecology Hospital,Fudan University from Jan.2013 to Jun.2021 was performed.The case group comprised women with an ECC CINⅠ(ECC results of CINⅠwith colposcopy-directed biopsy results≤CINⅠ),and the control group comprised women with a biopsy CINⅠ(colposcopy-directed biopsy results of CINⅠwith negative ECC findings)were divided after LEEP surgery and diagnosis in the next three months.The clinical data of all patients before LEEP were analyzed,and the pathological diagnosis between two groups after LEEP was compared.(2)Variables,including age,cytology,high-risk human papillomavirus(HR-HPV),ECC results,cervical transformation zone(TZ)and colposcopy impression,were included to describe the characteristics and compare the incidence of LEEP CINⅡ^(+).(3)Univariate analysis and Multivariate logistic regression method were used to analyze the related factors that affect the LEEP CINⅡ^(+)in CINⅠpatients.Further,the specific risks caused by related factors and conduct a stratified study in LEEP CINⅡ^(+)were analyzed.Results(1)Overall,2581 women with ECC CINⅠor biopsy CINⅠdiagnosis who underwent LEEP participated in the study with the mean age(43.6±9.5)years old.Chi square test found that the age and cytology of patients in ECC CINⅠgroup were statistically different from those of biopsy CINⅠgroup(all P<0.05).There was no significant difference in HR-HPV detection,TZ type and colposcopy impression between the two groups(all P>0.05).ECC CINⅠcomprised 957 women,with LEEP histopathology results revealing 288(30.1%,288/957)CINⅡ^(+),which was significantly

关 键 词：宫颈上皮内瘤样病变 宫颈肿瘤 刮除术 阴道镜检查 活组织检查 电外科手术 

分 类 号：R737.33[医药卫生—肿瘤]