阴道镜下活检确诊为CIN2的患者在LEEP术后发生病理升级的高危因素分析  

Analysis of high risk factors of pathological escalation after LEEP in CIN2 diagnosed by colposcopic biopsy

作　　者：马晓黎[1] 孟戈[1] 段华[1] Ma Xiaoli;Meng Ge;Duan Hua(Department of Gynecology Minimal Invasive Center,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院妇科微创中心/北京妇幼保健院,北京100006

出　　处：《新医学》2023年第12期895-901,共7页Journal of New Medicine

基　　金：国家重点研发计划生殖健康及重大出生缺陷防控研究重点专项(2018YFC1004803)。

摘　　要：目的 探讨阴道镜下活组织检查(活检)确诊为宫颈上皮内瘤变2级(CIN2)的患者在宫颈环形电切术(LEEP)后病理升级至CIN2以上(CIN2+)的相关风险因素,为CIN2患者的分层管理提供依据。方法 回顾性分析阴道镜下活检病理诊断宫颈CIN2而进一步行LEEP术的210例患者临床资料,观察患者在LEEP手术前、后的病理诊断,采用单因素及多因素Logistic回归分析患者年龄、初次液基薄层细胞学检查(TCT)结果、高危型人乳头瘤病毒(HPV)分型、阴道镜下病变累及象限数目、可见病变面积占宫颈表面积的比例、可见病变的最长线性长度、转化区类型、病变是否累及腺体和阴道镜图像特征等相关因素与LEEP术后病理升级的关系。结果 210例阴道镜下活检病理诊断的宫颈CIN2中,37例(17.6%)LEEP术后病理诊断为CIN2+,其中1例为宫颈鳞癌IB1期。单因素分析显示LEEP术后病理升级与患者年龄、阴道镜下病变累及象限数目、可见病变面积占宫颈表面积的比例、可见病变的最长线性长度、转化区类型及阴道镜图像特征有关(P均<0.05)。多因素分析显示,阴道镜下病变累及>1个象限、可见病变面积占宫颈表面积的比例≥1/3、转化区3型及阴道镜图像有2种及以上2级征象是LEEP术后病理升级的高危因素(P均<0.05)。对于26~50岁的患者,可见病变面积占宫颈表面积的比例≥1/3、转化区3型及阴道镜图像2种及以上2级征象是LEEP术后病理升级的高危因素(P均<0.05)。结论 阴道镜下宫颈活检确诊的CIN2中有漏诊CIN2+的情况存在,随着可见病变面积占宫颈表面积的比例增高(≥1/3)、阴道镜下鳞柱交接部不可见及阴道镜图像中2级征象占比增多(≥2个),漏诊CIN2+的风险增加。对于有生育意愿的CIN2患者如存在以上高危因素,建议谨慎选择随访观察。Objective To investigate the risk factors associated with pathological escalation to cervical intraepithelial neoplasia grade 2(CIN2)or above(CIN2+)in patients with CIN2 confirmed by colposcopic biopsy,aiming to provide evidence for the stratified management of CIN2 patients.Methods Clinical data of 210 patients who underwent LEEP surgery after pathological diagnosis of cervical CIN2 by colposcopic biopsy were retrospectively analyzed.Pathological diagnosis of patients before and after LEEP surgery was observed.The relationship between pathological escalation after LEEP,and age,results of primary liquid-based thin-layer cytology(TCT),typing of high-risk human papillomavirus(HPV),the number of affected quadrants of lesions under colposcopy,the proportion of visible lesion area to cervical surface area,the longest linear length of the lesion,the type of transformation zone(TZ),whether the lesion was involved with glands and the characteristics of colposcopic images was assessed by univariate and multivariate Logistic regression analyses.Results Among 210 cases of cervical CIN2 diagnosed by colposcopic biopsy,37 cases(17.6%)were pathologically diagnosed with CIN2+after LEEP,and 1 case was diagnosed with cervical squamous cell carcinoma stage IB1.Univariate analysis showed that pathological escalation after LEEP was associated with the age of patients,the number of affected quadrants of lesions under colposcopy,the proportion of visible lesion area to cervical surface area,the longest linear length of visible lesions,the type of transformation zone,and the characteristics of colposcoic images(all P<0.05).Multivariate analysis showed that the number(>1)of affected quadrants of lesions under colposcopy,the proportion(≥1/3)of visible lesion area to cervical surface area,TZ3 type and the characteristics(≥2)of colposcopic images were the high-risk factors for pathological escalation after LEEP(all P<0.05).For patients aged 26-50 years,the proportion(≥1/3)of lesion area to cervical surface area,TZ3 type and the

关 键 词：阴道镜检查 宫颈上皮内瘤样病变 宫颈环形电切术 病理升级 影响因素 液基薄层细胞学检查 

分 类 号：R737.33[医药卫生—肿瘤]