宫颈环形电切术后切缘阴性HSIL患者复发的相关危险因素分析  

Analysis of related risk factors for recurrence in HSIL patients after LEEP surgery with negative nargins

作　　者：李小梅 李莉[1] 韩淑霞[2] LI Xiaomei;LI Li;HAN Shuxia(Ningxia Medical University,Yinchuan 750004,China;Department of Gynecology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学,宁夏银川750004 [2]宁夏医科大学总医院妇科,宁夏银川750004

出　　处：《宁夏医学杂志》2025年第3期199-203,F0003,共6页Ningxia Medical Journal

基　　金：宁夏科技惠民项目(2021CMG03004);宁夏卫生健康适宜技术推广项目(2022NWSY013)。

摘　　要：目的研究影响宫颈高级别鳞状上皮内病变(HSIL)患者进行宫颈环形电切术(LEEP)术后切缘为阴性,最终复发的相关因素,以此构建列线图模型并进行模型的评价。方法收集诊断为HSIL并进行LEEP治疗后切缘阴性的334例患者资料,根据随访结果将其分为复发组和未复发组,比较2组患者一般资料及手术相关资料,使用logistic回归方法分析得出影响复发的独立危险因素,使用R软件建立复发列线图预测模型并验证其效能。结果334例患者中复发组有30例,总复发率为9%,logistic回归分析结果显示,复发组患者与未复发组患者在绝经、病理级别为宫颈上皮内瘤样病变(CIN)Ⅲ级、病变累及多个象限、术后HPV持续感染方面比较差异有统计学意义(P<0.05)。构建列线图模型后,结果表明该模型区分度佳,临床应用价值高。结论绝经、病理级别为CINⅢ级、病变累及多个象限、术后HPV持续感染为影响宫颈HSIL患者LEEP术后切缘阴性复发的独立危险因素,以此建立的列线图模型区分度良好,临床实用价值高。Objective To investigate the independent risk factors affecting the recurrence of patients with high-grade squamous intraepithelial lesion(HSIL)after undergoing LEEP surgery with negative margins,and to construct a nomogram model and evaluate its performance.Methods A total of 334 patients with HSIL diagnosed at the cervical lesion outpatient clinic were collected,and the patients were divided into the recurrence group and non-recurrence group according to the follow-up results.The general information and surgical-related data of the two groups were compared,and the independent risk factors affecting recurrence were analyzed.A recurrence nomogram prediction model was established using R software,and its performance was validated.Results A total of 334 patients were included,with 30 cases of recurrence,resulting in a postoperative total recurrence rate of 9%.Logistic regression analysis showed that the recurrence group and non-recurrence group were statistically different in terms of menopause,pathological grade of CIN3,involvement of multiple quadrants,and persistent HPV infection after surgery(P<0.05).After constructing a receiver operating characteristic(ROC)curve model,the results showed that the model had excellent discriminatory ability and high clinical application value.Conclusion Menopause,pathological grade of CIN3,involvement of multiple quadrants,and persistent HPV infection after surgery are independent risk factors for LEEP surgery negative resection margin recurrence in cervical HSIL patients.The ROC curve of model establishment based on these factors has good discriminatory ability and high clinical practical value.

关 键 词：宫颈上皮内瘤变 宫颈环形电切术 列线图 预测模型 

分 类 号：R711[医药卫生—妇产科学]