绝经宫颈癌前病变患者锥切术后切缘阳性的影响因素分析  

Analysis of influencing factors of positive margin after conization in postmenopausal women with cervical precancerous lesions

作　　者：徐子杰 张岱[2] 米兰[2] 郑晓云 郑华[1] 毕蕙[2] Xu Zijie;Zhang Dai;Mi Lan;Zheng Xiaoyun;Zheng Hua;Bi Hui(Department of Gynecology,Beijing Chaoyang District Maternal and Child Health Care Hospital,Beijing 100034,China)

机构地区：[1]北京市朝阳区妇幼保健院妇科,100034 [2]北京大学第一医院妇产科

出　　处：《北京医学》2024年第4期263-267,共5页Beijing Medical Journal

基　　金：北京市医院管理中心临床医学发展专项——“扬帆”计划(XMLX202131)。

摘　　要：目的探讨绝经宫颈癌前病变患者锥切术后切缘阳性的影响因素。方法选取2013年1月至2019年12月北京大学第一医院行锥切术的绝经宫颈癌前病变患者471例。根据切缘状态分为切缘阳性组(122例)和切缘阴性组(349例)。采用多因素logistic回归方程分析绝经宫颈癌前病变患者锥切术后切缘阳性的影响因素。结果471例患者中,切缘阳性122例(25.90%),其中内切缘阳性81例(17.20%),外切缘阳性22例(4.67%),基底切缘阳性19例(4.03%)。多因素logistic回归分析结果显示,经液基薄层细胞学(thinprep cytology test,TCT)结果为高级别异常(OR=2.719,95%CI:1.152~3.483,P=0.000)、HPV 16/18(+)感染(OR=3.139,95%CI:1.781~6.984,P=0.000)、2017风险评估为中高风险(OR=2.926,95%CI:1.419~9.483,P=0.017)、病理活检为高级别鳞状上皮内病变(OR=1.913,95%CI:1.427~4.806,P=0.018)、病变范围>3个象限(OR=1.716,95%CI:1.142~2.984,P=0.011)的患者椎切术后更容易出现切缘阳性。结论绝经宫颈癌前病变患者锥切术后切缘阳性的发生率较高。TCT结果、HPV感染、2017风险评估、病理活检及病变范围是切缘阳性的影响因素。Objective To explore the influencing factors of positive margin after conization in postmenopausal women with cervical precancerous lesions.Methods A total of 471 patients with cervical precancerous lesions who underwent conical resection in Peking University First Hospital from January 2013 to December 2019 were were selected,and were divided into margin positive group(122 cases)and margin negative group(349 cases)according to the status of margin.The influencing factors of positive margin after conization in postmenopausal women with cervical precancerous lesions was analyzed by multivariate logistic regression equation.Results Among the 471 patients,122 cases(25.90%)were positive for incisal margin,including 81 cases(17.20%)for internal margin,22 cases(4.67%)for external margin and 19 cases(4.03%)for basal margin.Multivariate logistic regression analysis showed that patients with high-grade abnormal thinprep cytology test(TCT)results(OR=2.719,95%CI:1.152-3.483,P=0.000),HPV 16/18(+)infection(OR=3.139,95%CI:1.781-6.984,P=0.000),medium-high risk in 2017 risk assessment(OR=2.926,95%CI:1.419-9.483,P=0.017),pathological biopsy high-grade squamous intraepithelial lesions(OR=1.913,95%CI:1.427-4.806,P=0.018)and lesion range>3 quadrants(OR=1.716,95%CI:1.142-2.984,P=0.011)were more likely to have positive margin after vertebrotomy.Conclusions The incidence of positive margin after conization in postmenopausal women with cervical precancerous lesions is high.TCT results,HPV infection,risk assessment in 2017,pathological biopsy and lesion scope are the influencing factors of positive margin.

关 键 词：宫颈癌前病变 锥切术 切缘阳性 影响因素 

分 类 号：R737.33[医药卫生—肿瘤]