宫颈腺性病变行宫颈锥切术后切缘阳性的相关因素分析  

Analysis of the factors related to the positive margin of cervical glandular lesions after cervical conization

作　　者：张书 赵昀[1] 李明珠[1] 赵超[1] 崔淑慧[1] 赵丽君[1] 任丽华[1] 李燕燕 汪俊涛[2] 孙秀丽[1] 王建六[1] 魏丽惠[1] ZHANG Shu;ZHAO Yun;LI Mingzhu;ZHAO Chao;CUI Shuhui;ZHAO Lijun;REN Lihua;LI Yanyan;WANG Juntao;SUN Xiuli;WANG Jianliu;WEI Lihui(Department of Obstetrics and Gynecology,Peking University People's Hospital,Beijing,100044,China;Guiyang Maternal and Child Health Care Hospital,Guiyang,550003,China)

机构地区：[1]北京大学人民医院妇产科,北京100044 [2]贵阳市妇幼保健院,贵阳550003

出　　处：《中国妇产科临床杂志》2023年第2期132-136,共5页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：北京大学人民医院研究与发展基金(RDH2019-02);妇幼健康研究会资助项目(2018AMCHS008002)。

摘　　要：目的探索宫颈腺性病变行宫颈锥切术后切缘阳性的相关因素。方法回顾性分析2012年1月至2022年4月于北京大学人民医院妇科宫颈锥切术后经病理证实的腺性病变78例患者的临床病理学资料。结果(1)一般资料:78例患者中,无临床症状者占69.23%(54/78);有症状者占30.77%(24/78)。(2)筛查结果:78例患者中,65例行宫颈细胞学筛查,其中宫颈细胞学正常者占41.54%(27/65),细胞学异常者(≥ASC-US)占58.46%(38/65);71例有HPV结果,HPV阳性率95.77%(68/71),其中单一感染较多,占80.88%(55/68),HPV 16为最常见的型别,占47.06%(32/68),其次为HPV 18,占36.76%(25/68)。(3)病理情况:宫颈锥切术前活检病理鳞状上皮病变占33.33%(26/78),腺性病变占66.67%(52/78);锥切术后确诊单纯腺性病变者占37.18%(29/78),腺性病变合并鳞状上皮病变者占62.82%(49/78),其中53.85%(42/78)的腺性病变呈多灶跳跃性。(4)切缘阳性与年龄、临床症状、筛查结果、HPV感染状态、活检前病理诊断、标本大小及手术方式等无关(P>0.05),与病灶是否具有跳跃性相关(χ^(2)=15.528;P=0.000);病灶呈多灶性患者的切缘阳性率相对于非多灶性患者增加12.1%(95%CI:0.039~0.373);切缘状态与阴道镜下的特征性图像无关(P>0.05)。结论宫颈腺性病变锥切切缘阳性与腺性病灶的跳跃性有关。Objective To explore the factors related to the positive margin of cervical glandular lesions after cervical conization.Methods The clinicopathological data of 78 patients diagnosed with glandular lesions after cervical conization in Peking University People’s Hospital from January 2012 to April 2022 were analyzed retrospectively.Results(1)General data:Among 78 patients,69.23%(54/78)were clinically asymptomatic;30.77%(24/78)had symptoms.(2)Screening results:Among 78 patients,65 patients underwent cytological screening,of which 41.54%(27/65)had normal cytology and 58.46%(38/65)had abnormal cytology(≥ASC-US);71 cases had HPV results.The positive rate of HPV was 95.77%(68/71),of which single infection was more common,accounting for 80.88%(55/68).HPV 16 was the most common type,accounting for 47.06%(32/68),followed by HPV 18,accounting for 36.76%(25/68).(3)Pathological diagnosis:Before conization,33.33%(26/78)was diagnosed with squamous epithelial lesions,and only 66.67%(52/78)diagnosed with glandular lesions.After conization,37.18%(29/78)of the patients were diagnosed with glandular lesions,and 62.82%(49/78)were diagnosed as glandular lesions combined with squamous epithelial lesions;53.85%(42/78)of glandular lesions showed multifocal“skip”lesions.(4)The positive margin was not related to age,clinical symptoms,screening results,HPV infection status,pathological diagnosis before biopsy,specimen size and operation mode(P>0.05),but was related to whether the lesions had“skip”characteristics(χ^(2)=15.528;P=0.000);The positive rate of margins in patients with multifocal lesions was 12.1%times higher than that in patients without multifocal lesions(OR:0.121,95%CI:0.039~0.373);The state of incisional margin was not related to the typical colposcopy impression(P>0.05).Conclusions The positive margin of cervical glandular lesions is related to the“skip”lesions.

关 键 词：宫颈腺性病变 宫颈锥切术 切缘阳性 影响因素 

分 类 号：R737.33[医药卫生—肿瘤]