宫颈锥切术后切缘阳性及病变残留的危险因素分析  

Risk factors analysis for positive margins and residual lesions after cervical cone biopsy

作　　者：时文丽 Shi Wenli(Department of Gynaecology,the First People's Hospital,Shangqiu,Henan 476000,China)

机构地区：[1]商丘市第一人民医院妇科,河南商丘476000

出　　处：《齐齐哈尔医学院学报》2025年第5期465-469,共5页Journal of Qiqihar Medical University

摘　　要：目的宫颈锥切术是治疗宫颈病变的有效方式之一,但术后仍存在切缘阳性及残留病变,因此本研究重点分析相关影响因素。方法回顾性分析2021年4月-2023年4月本院收治的行宫颈锥切术治疗的宫颈高级别上皮内病变(HSIL)、宫颈微小浸润癌(MIC)的患者258例的临床资料。利用多因素Logistic回归模型分析宫颈锥切术后切缘阳性的危险因素;258例患者中有78例进一步行子宫切除术治疗,利用与上述相同的统计学方法分析病变残留的危险因素。结果258例患者中,经宫颈锥切术后59例(22.87%)切缘阳性,切缘阴性199例(77.13%);其中有78例患者经宫颈锥切术后3个月内进一步行子宫切除术治疗,发现病变残留者23例(29.49%)。切缘阳性组与切缘阴性组HR-HPV感染种类、病变级别、累及腺体、转化区类型比较,差异显著(P<0.05)。Logistic回归分析结果提示,HR-HPV感染种类(≥2种)、病变级别(MIC)、累及腺体(是)、转化区类型(3型)均是宫颈锥切术后切缘阳性的危险因素(P<0.05)。病变残留组HR-HPV感染种类≥2种占比、病变级别为MIC占比、切缘阳性占比均比对照组高(P<0.05)。Logistic回归分析结果提示,HR-HPV感染≥2种、病变为MIC、切缘阳性是宫颈锥切术后病变残留的危险因素(P<0.05)。结论HR-HPV感染种类、病变级别、累及腺体、转化区类型与切缘阳性密切相关;HR-HPV感染≥2种、病变为MIC、切缘阳性是术后病变残留的危险因素,应重视高危人群管理。Objective Cervical cone biopsy is an effective method for treating cervical lesions,yet positive margins and residual lesions remain after surgery.This study focuses on analyzing the influencing factors.Methods Retrospective analysis was conducted on clinical data of 258 patients with cervical high-grade squamous intraepithelial lesions(HSIL)and cervical microinvasive carcinoma(MIC)who underwent cervical cone biopsy treatment at our hospital from April 2021 to April 2023.A multifactor logistic regression model was used to analyze the risk factors for positive margins post-cervical cone biopsy.Among the 258 patients,78 cases were treated with further hysterectomy.The same statistical methods were used to analyze the risk factors for residual lesions.Results Among the 258 patients,59 cases(22.87%)had positive margins and 199(77.13%)had negative margins after cervical cone biopsy.Of the 78 patients who underwent hysterectomy within 3 months post-cervical cone biopsy,23 cases(29.49%)had residual lesions.Significant differences were observed in HR-HPV infection types,lesion grades,gland involvement,and transformation zone types between the positive and negative margin groups(P<0.05).Logistic regression analysis indicated that HR-HPV infection types(≥2),lesion grade(MIC),gland involvement(yes),and transformation zone type(type 3)were all risk factors for positive margins post-cervical cone biopsy(P<0.05).The group with residual lesions had higher proportions of HR-HPV infection types(≥2),MIC lesion grade,and positive margins compared to the control group(P<0.05).Logistic regression analysis showed that HR-HPV infection(≥2),MIC lesion grade,and positive margins were risk factors for residual lesions post-cervical cone biopsy(P<0.05).Conclusions HR-HPV infection types,lesion grade,gland involvement,and transformation zone type are closely related to positive margins.HR-HPV infection(≥2),MIC lesion grade,and positive margins are risk factors for postoperative residual lesions,and management of high-risk population

关 键 词：宫颈锥切术 病变残留 切缘阳性 宫颈高级别上皮内病变 宫颈微小浸润癌 危险因素 

分 类 号：R73[医药卫生—肿瘤]