宫颈病变冷刀锥切术后切缘阳性及病变残留的危险因素分析  

Analysis on risk factors of positive surgical margin and residual lesion after cervical cold knife conization of cervical lesions

作　　者：王淑玲 拜莹 李嘉荣 赵卫红 WANG Shuling;BAI Ying;LI Jiarong;ZHAO Weihong(School of Public Health,Shanxi Medical University,Shanxi Taiyuan 030000,China;Department of Gynecology,the Second Affiliated Hospital of Shanxi Medical University,Shanxi Taiyuan 030001,China)

机构地区：[1]山西医科大学公共卫生学院,山西太原030000 [2]山西医科大学第二医院妇产科,山西太原030001

出　　处：《现代肿瘤医学》2022年第23期4303-4308,共6页Journal of Modern Oncology

基　　金：国家自然科学基金项目(编号:81702583);中国博士后科学基金项目(编号:2019M651072);山西省应用基础研究计划(编号:201901D211506)。

摘　　要：目的:研究因宫颈病变行冷刀锥切术后切缘阳性及病变残留的危险因素。方法:回顾性分析2018年09月至2021年04月在山西医科大学第二医院妇科行宫颈冷刀锥切术经病理组织学诊断为HSIL及MIC的429例患者的临床资料,采用单因素分析及多因素Logistic回归分析年龄、绝经状态、孕次、产次、同房出血、不规则出血、家族肿瘤史、HR-HPV感染种类、HPV16/18感染、TCT检测结果、转化区类型、宫颈管搔刮术(endocervical curettage,ECC)结果、病变级别、是否累及腺体与宫颈冷刀锥切术后切缘阳性是否相关。同时,对79例进一步行子宫切除术者分析切缘阳性及上述相关因素与术后病变残留的关系。结果:术后切缘阳性与TCT检测结果、转化区类型、病变级别、是否累及腺体、ECC结果有关(P<0.05),其中MIC、累及腺体、3型转化区及ECC阳性是宫颈冷刀锥切术后切缘阳性的独立危险因素(P<0.05)。此外,宫颈病变残留与切缘状态及病变级别有关(P=0.001;P=0.038),切缘阳性是子宫切除术后病变残留的独立危险因素(P=0.002)。结论:重视宫颈冷刀锥切术后切缘阳性的危险因素,指导临床个体化干预,是降低切缘阳性和病变残留的重要措施。Objective:To investigate the risk factors for positive surgical margin and residual lesion after cervical cold knife conization of cervical lesions.Methods:429 cases of cervical cold knife conization,pathologically diagnosed as HSIL and MIC were retrospectively analyzed at the Department of Gynecology,Second Hospital of Shanxi Medical University from September 2018 to April 2021.The relations between positive surgical margins after cervical cold knife conization and age,menopausal status,pregnancy,parity,bleeding after intercourse,irregular bleeding,family history of tumors,high-risk human papilloma virus(HR-HPV)types,HPV16/18 infection,TCT test,type of transformation zone,ECC results,lesion grade,glandular involvement were analyzed by univariate and multivariate logistic regression.The same method was used to analyze the correlation between these factors and positive margins and residual lesions in 79 patients who underwent hysterectomy.Results:Univariate and multivariate analyses showed that positive margins were correlated with TCT results,type of transformation zone,lesion grade,glandular involvement,and ECC results(P<0.05).And MIC,glandular involvement,type 3 transformation zone,and ECC positive result were independent risk factors for positive margin(P<0.05).In addition,residual lesions were significantly associated with margin status and lesion grade(P=0.001;P=0.038),and positive margin was an independent risk factor of residual lesions after hysterectomy(P=0.002).Conclusion:Focusing on risk factors for positive margins after cervical cold knife conization and guiding individualized clinical interventions are important measures to reduce positive margins and lesion residuals.

关 键 词：宫颈高级别上皮内病变 微小浸润癌 宫颈冷刀锥切术 切缘阳性 病变残留 危险因素 

分 类 号：R737.33[医药卫生—肿瘤]