宫颈高级别鳞状上皮内病变术后复发情况及影响因素  

Investigation of postoperative recurrence and its influencing factors in patients with high-grade squamous intraepithelial lesions of the uterine cervix

作　　者：幸霏 童艳英 饶萍萍 XING Fei;TONG Yanying;RAO Pingping(Department of Obstetrics and Gynecology,Guangchang Maternal and Child Health Hospital,Fuzhou,Jiangri 344900,China)

机构地区：[1]广昌县妇幼保健院妇产科,江西抚州344900

出　　处：《社区医学杂志》2024年第21期736-740,共5页Journal Of Community Medicine

摘　　要：目的探讨宫颈高级别鳞状上皮内病变(HSIL)患者术后复发情况及其影响因素。方法用便利抽样方式选择2017-01-01-2022-09-30在广昌县妇幼保健院行手术治疗的186例HSIL患者为研究对象,收集患者年龄、是否绝经、孕次、产次、累及腺体、性伴侣数、切缘类型、手术方式、术后HPV感染、吸烟史等资料。观察HSIL患者术后复发情况,单因素及logistic回归分析HSIL患者术后复发的相关影响因素。结果186例HSIL患者术后复发20例(10.75%),未复发166例(89.25%);单因素分析结果显示,复发组年龄≥45岁(χ^(2)=4.776,P=0.029)、绝经(χ^(2)=6.270,P=0.012)、累及腺体(χ^(2)=12.253,P<0.001)、切缘阳性(χ^(2)=4.045,P=0.044)、宫颈环形电切除术(LEEP)比例(χ^(2)=7.875,P=0.005)、术后人乳头瘤病毒(HPV)感染(χ^(2)=4.017,P=0.045)、吸烟史(χ^(2)=6.298,P=0.012)比例高于未复发组,差异有统计学意义;2组患者孕次、产次、性伴侣数比较,差异无统计学意义,均P>0.05;多因素分析结果显示,年龄≥45岁(β=1.027,OR=2.793,95%CI为1.080~7.221)、绝经(β=1.311,OR=3.709,95%CI为1.412~9.741)、累及腺体(β=1.837,OR=6.277,95%CI为2.245~17.548)、切缘阳性(β=1.159,OR=3.186,95%CI为1.154~8.796)、LEEP(β=1.365,OR=3.914,95%CI为1.430~10.711)、术后HPV感染(β=1.106,OR=3.022,95%CI为1.136~8.037)、吸烟史(β=1.649,OR=5.200,95%CI为1.571~17.215)是HSIL患者术后复发的高危因素,均P<0.05。结论HSIL患者术后易复发,其受年龄、绝经、累及腺体、切缘类型、手术方式、术后HPV感染、吸烟史影响。Objective To explore the postoperative recurrence of patients with high-grade squamous intraepithelial lesion(HSIL)of the cervix and its influencing factors.Methods Totally 186 cases of HSIL patients who underwent surgical treatment in Guangchang County Maternal and Child Health Hospital from January 1,2017 to September 30,2022 were selected by convenience sampling as the study subjects.Data including age,menopausal status,pregnancy history,childbirth history,involvement of glands,number of sexual partners,margin type,surgical method,postoperative HPV infection,and smoking history were collected.The recurrence of HSIL after surgery was observed,and univariate and logistic regression analyses were conducted to identify the related influencing factors of postoperative recurrence.Results There were 20 cases(10.75%)of 186 HSIL patients experiencing postoperative recurrence and 166 cases(89.25%)did not have recurrence.Univariate analysis showed that the proportions of age≥45 years(χ^(2)=4.776,P=0.029),menopause(χ^(2)=6.270,P=0.012),involvement of glands(χ^(2)=12.253,P<0.001),positive margins(χ^(2)=4.045,P=0.044),cervical loop electrosurgical excision procedure(LEEP)proportion(χ^(2)=7.875,P=0.005),postoperative human papillomavirus(HPV)infection(χ^(2)=4.017,P=0.045),and history of smoking(χ^(2)=6.298,P=0.012)in the recurrence group were higher than those in the non-recurrent group,and the differences were statistically significant;however,there were no statistically significant differences when comparing the number of pregnancies,deliveries,and number of sexual partners between the two groups(all P>0.05).Multifactorial analysis showed that age≥45 years(β=1.027,OR=2.793,95%CI was 1.080-7.221),menopause(β=1.311,OR=3.709,95%CI was 1.412-9.741),involvement of glands(β=1.837,OR=6.277,95%CI was 2.245-17.548),positive margins(β=1.159,OR=3.186,95%CI was1.154-8.796),LEEP(β=1.365,OR=3.914,95%CI was 1.430-10.711),postoperative HPV infection(β=1.106,OR=3.022,95%CI was 1.136-8.037),and a history of smoking(β=1.649

关 键 词：宫颈高级别鳞状上皮内病变 复发 绝经 切缘阳性 HPV感染 

分 类 号：R737.3[医药卫生—肿瘤]