宫颈高级别鳞状上皮内病变活检与宫颈锥切术后病理学降级的影响因素分析  

Analysis of influencing factors of pathological degradation between colposcopic directed cervical biopsy and conization in high-grade squamous intraepithelial lesion

作　　者：田鹏飞 张海凤[2] 曹成成[2] 张友忠[3] 刘玉珍[2] TIAN Pengfei;ZHANG Haifeng;CAO Chengcheng;ZHANG Youzhong;LIU Yuzhen(Department of Obstetrics and Gynecology,Weifang Medical University,China;Department of Gynecology,Affiliated Hospital of Weifang Medical University,Weifang 261041,China;Department of Gynecology,Qilu Hospital of Shandong University,Jinan 250063,China)

机构地区：[1]潍坊医学院临床学院妇产科学教研室 [2]潍坊医学院附属医院妇科,山东潍坊方261053 [3]山东大学齐鲁医院妇科,济南250063

出　　处：《中国妇产科临床杂志》2023年第2期140-143,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：国家自然科学基金(81572559);潍坊医学院科研基金(2017BSQD43)。

摘　　要：目的探讨阴道镜下宫颈活检确诊为宫颈高级别鳞状上皮内病变(high grade squamous intraepithelial lesion,HSIL)并行宫颈锥切患者术后病理学降级的发生率及其影响因素。方法收集2016年1月至2021年6月于潍坊医学院附属医院宫颈病变中心阴道镜下宫颈活检确诊为HSIL并行宫颈锥切术的患者1499例为研究对象,其中419例(27.95%,419/1499)患者锥切术后发生病理诊断降级【宫颈活检标本诊断为HSIL,锥切术后诊断为低级别鳞状上皮内病变(low grade squamous intraepithelial lesion,LSIL)及以下】,包括LSIL1267例(63.72%)和慢性宫颈炎152例(36.28%)。依据锥切术后病理分级与活检分级是否存在病理学降级分为研究组(病理学降级组)和对照组(无病理学降级组)。比较两组患者的年龄、液基细胞学检查(TCT)、人乳头瘤病毒(HPV)、阴道镜诊断结果、转化区分型、转化区暴露是否充分、病灶大小、病变是否累及腺体及活检-锥切间隔时间等。结果(1)研究组年龄【(34.54±8.17)岁】与对照组年龄【(49.39±5.34)岁】比较,差异有统计学意义(P<0.05);研究组病变累及腺体【45.82%(192/419)】与对照组【89.35%(965/1080)】比较,差异有统计学意义(P<0.05);研究组宫颈活检-锥切间隔时间【(77.30±16.35)d】与对照组【(23.80±12.04)d】比较,差异有统计学意义(P<0.05);研究组TCT、HPV、阴道镜诊断结果、转化区分型、转化区暴露是否充分及病灶大小与对照组比较,差异均无统计学意义(P>0.05)。(2)logistic回归多因素分析显示,年龄、病变是否累及腺体和活检-锥切间隔时间是宫颈锥切术后发生病理学降级的独立影响因素(P<0.05),其OR值分别为1.263、5.539和0.829。结论宫颈HSIL锥切术后病理学降级的发生率较高,其独立影响因素为年龄、病变是否累及腺体和活检-锥切间隔时间。Objective To investigate the incidence and influencing factors of pathological degradation in patients diagnosed with high-grade squamous intraepithelial lesion(HSIL)under the guidance of colposcopy and cervical conization.Methods 1499 patients underwent conization for cervical HSIL in the Cervical Lesion Center of Affiliated Hospital of Weifang Medical University from January 2016 to June 2021 were enrolled.Pathological degradation which refers to cervical biopsy specimen was diagnosed as HSIL,and excision biopsy specimen was diagnosed as low grade squamous intraepithelial lesion(LSIL)and below,occurred in 419(27.95%,419/1499)patients including 267 cases(63.72%)LSIL and 152 cases(36.28%)chronic cervicitis.The patients were divided into study group(with pathological degradation)and control group(no pathological degradation).Possible influencing factors between the two groups were compared:age,cytology,HPV test,colposcopy assessment,type of transformation zone,lesion size,the glandular involvement,time interval from biopsy to conization,etc.Results(1)Compared the age of the study group[(34.54±8.17)years]and the control group[(49.39±5.34)years],the difference was statistically significant(P<0.05).Compared the glandular involvement in the study group[45.82%(192/419)]and in the control group[89.35%(965/1080)],the difference was statistically significant(P<0.05).Compared the time interval from biopsy to conization in the study group[(77.30±16.35)d]and the control group[(23.80±12.04)d],the difference was with statistically significance(P<0.05).There were no significant differences in TCT,HPV,colposcopy assessment,type of transformation zone,lesion size between the study group and the control group(P>0.05).(2)The results of multivariate analysis of Logistic regression showed that age,glandular involvement and time interval from biopsy to conization were independent influencing factors for pathological degradation after conization.The OR values were 1.263,5.539 and 0.829,respectively.Conclusions The incidence of path

关 键 词：阴道镜检查 活检 病理学降级 高级别鳞状上皮内病变 宫颈锥切术 

分 类 号：R737.33[医药卫生—肿瘤]