宫颈高级别鳞状上皮内病变LEEP术后病灶复发危险因素分析  

Risk Factors for Recurrence of Cervical High-grade Squamous Intraepithelial Lesions after LEEP

作　　者：相里洁茹 韩莉莉[2] XIANGLI Jie-ru;HAN Li-li(Graduate School,Medical College of Shihezi University,Shihezi,Xinjiang 832000,China;Department of Gynecology People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi,Xinjiang 830001,China)

机构地区：[1]石河子大学医学院研究生学院,新疆石河子832000 [2]新疆维吾尔自治区人民医院妇科,新疆乌鲁木齐830001

出　　处：《河北北方学院学报(自然科学版)》2025年第4期14-19,共6页Journal of Hebei North University:Natural Science Edition

基　　金：新疆维吾尔自治区重点研发专项计划项目(No.2022B03018-1)。

摘　　要：目的 探讨HSIL(宫颈高级别鳞状上皮内病变)LEEP术后病灶复发及其影响因素。方法 回顾性分析516例HSIL实施LEEP术患者的临床资料及2年随访记录,分析患者一般情况(民族、年龄、孕产次、绝经状况等)及临床病理因素(术前和术后24个月的HPV感染状态、TCT、阴道炎感染情况、阴道镜下转化区类型、活检病理等级、腺体受累情况及环切深度、切缘情况等)与病变复发的相关性,多因素分析采用Logistic回归模型分析独立危险因素。结果 516例患者中,术后复发24例(4.65%)。少数民族、年龄≥50岁、经阴分娩≥2次、绝经、活检CIN3级、3型转化区、活检累腺、环切深度≥15 mm、切缘阳性、术前HPV载量≥1 000 RLU与术后复发相关(P<0.05)。Logistic回归分析显示3型转化区、切缘阳性、术前HPV载量≥1 000 RLU是术后复发的独立危险因素(OR分别为3.380、5.397、3.715,P<0.05)。结论 活检3型转化区、切缘阳性、术前HPV载量≥1 000 RLU是HSIL患者宫颈LEEP术后复发的独立危险因素,须严密随访和管理,在遵循个体化原则的前提下给予及时有效干预。Objective To investigate the recurrence of HSIL(high-grade squamous intraepithelial lesion)after LEEP and its influencing factors.Methods The clinical data and 2-year follow-up records of 516 patients who underwent LEEP for HSIL were retrospectively analyzed.The general conditions(ethnicity,age,gravidity and parity,menopausal status,etc.)and clinicopathological factors(HPV infection status,TCT,vaginitis infection,type of conversion zone under colposcope,pathological grade of biopsy,glandular involvement,girth cutting depth,margin,etc.before and 24 months after operation)were analyzed.The correlation between the recurrence of the lesion and general conditions as well as clinicopathological factors was analyzed.Logistic regression model was used to analyze the independent risk factors.Results Of the 516 patients,24(4.65%)had postoperative recurrence.Ethnic minorities,age≥50 years old,vaginal delivery≥2 times,menopause,biopsy CIN3,type 3 transformation zone,biopsy gland,girth cutting depth≥15 mm,positive margin,preoperative HPV load≥1000 RLU were associated with postoperative recurrence(P<0.05).Logistic regression analysis showed that type 3 transformation zone,positive margin and preoperative HPV load≥1000 RLU were independent risk factors for postoperative recurrence(OR=3.380,5.397,3.715,P<0.05).Conclusion Biopsy type 3 transformation zone,positive margin,and preoperative HPV load≥1000 RLU are independent risk factors for recurrence after cervical LEEP in HSIL patients.It is necessary to closely follow up and manage,and give timely and effective intervention on the premise of following the principle of individualization.

关 键 词：宫颈高级别鳞状上皮内病变 宫颈环形电切除术 复发 危险因素 

分 类 号：R737.33[医药卫生—肿瘤]