不同宫颈转化区类型对HSIL患者LEEP术后切缘阳性的影响  

Influence of different types of cervical transformation zone on the positive surgical margin after LEEP in patients with HSIL

作　　者：李庆梅[1] 王兴红[1] 李耀[1] 庞飞 LI Qingmei;WANG Xinghong;LI Yao;PANG Fei(Yulin Maternal and Child Health Hospital,Guangxi Yulin 537000,China)

机构地区：[1]玉林市妇幼保健院,广西玉林537000

出　　处：《中国妇幼健康研究》2023年第7期99-105,共7页Chinese Journal of Woman and Child Health Research

摘　　要：目的 探讨不同宫颈转化区类型对高度鳞状上皮内病变(HSIL)患者宫颈环形电刀切除术(LEEP)术后切缘阳性的影响及原因。方法 选取2019年1月至2021年12月在玉林市妇幼保健院行LEEP治疗的1 084例HSIL患者为研究对象,根据其LEEP术切除标本的病理诊断结果分为切缘阳性组(n=159)和切缘阴性组(n=925)。比较不同宫颈转化区(TZ)类型HSIL患者的病理结果;比较切缘阳性组和阴性组患者的临床资料,采用多因素Logistic逐步回归模型筛选HSIL患者术后切缘阳性的独立危险因素,基于此建立列线图并对模型进行验证。结果 TZⅠ型、Ⅱ型、Ⅲ型HSIL患者的切缘阳性率分别为9.30%、12.31%、20.31%,差异有统计学意义(χ^(2)=9.336,P<0.05)。切缘阳性组和阴性组患者的HPV感染情况、HPV分型、TZ分型、病变程度、是否累及腺体的差异均有统计学意义(χ^(2)值分别为2.933、8.681、9.336、8.729、6.435,P<0.05);多因素分析显示,HPV感染呈多型阳性、HPV16/18分型感染、TZⅢ型、CINⅢ度病变、病灶累及腺体是导致HSIL患者LEEP术后切缘阳性的独立危险因素(OR值分别为2.061、1.908、2.455、2.836、2.908,P<0.05)。基于此建立了预测HSIL患者术后切缘阳性的列线图模型。经验证,列线图模型的区分度较高,预测模型与实际发生概率具有较高的一致性。结论 不同宫颈转化区类型与HSIL患者LEEP术后切缘阳性有相关性,TZⅢ型是影响术后切缘阳性的独立危险因素,且具有较高的预测价值。Objective To explore the influence of different types of cervical transformation zone on positive surgical margin after loop electrosurgical excision procedure(LEEP)in patients with high grade squamous intraepithelial lesion(HSIL)and its causes.Methods A total of 1,084 patients with HSIL who were treated with LEEP in our hospital from January 2019 to December 2021 were selected as subjects.According to the pathological diagnosis results of LEEP excision specimens,the patients were divided into the positive margin group(n=159)and the negative margin group(n=925).The pathological results of HSIL patients with different types of cervical transformation zone(TZ)were compared.The clinical data of patients in the positive margin group and the negative margin group were compared.Multivariate Logistic stepwise regression model was used to screen the independent risk factors for positive surgical margin in patients with HSIL,based on which a histogram was established and the model was verified.Results The positive rates of positive surgical margin in HSIL patients with TZ typeⅠ,typeⅡand typeⅢwere 9.30%,12.31%and 20.31%,respectively.The difference was statistically significant(χ^(2)=9.336,P<0.05).There were significant differences in HPV infection,HPV classification,TZ classification,lesion degree and glandular involvement between the positive group and the negative group(χ^(2)=2.933,8.681,9.336,8.729 and 6.435,respectively,P<0.05).Multivariate analysis showed that positive HPV infection,HPV16/18 type infection,TZ typeⅢ,CIN gradeⅢlesion and lesion involving gland were independent risk factors for positive surgical margin after LEEP in patients with HSIL(OR=2.061,1.908,2.455,2.836 and 2.908,respectively,P<0.05).Based on above,a histogram model was established to predict the positive surgical margin in patients with HSIL.It is proved that the line chart model had great discrimination.The prediction model is highly consistent with the actual occurrence probability.Conclusion Different types of cervical transformat

关 键 词：宫颈转化区 高度鳞状上皮内病变 宫颈环形电刀切除术 切缘阳性 

分 类 号：R173[医药卫生—妇幼卫生保健]