LEEP与CKC治疗高级别宫颈鳞状上皮内病变术后切缘阳性危险因素分析

Analysis of risk factors for positive surgical margins after LEEP and CKC in the treatment of high-grade cervical squamous intraepithelial lesions

目的回顾性分析高级别宫颈鳞状上皮内病变患者接受宫颈环形电切术(LEEP)或宫颈冷刀锥切术(CKC)术后病历资料,分析术后切缘阳性的危险因素,为高级别宫颈鳞状上皮内病变患者的治疗提供参考依据。方法选取乌鲁木齐市某三甲医院妇科2019年1月1日-2021年12月31日诊断结果为高级别宫颈鳞状上皮内病变的患者,按照患者手术方法的不同分为LEEP组和CKC组,对比两组患者手术指标及切缘阳性率以分析两组手术方式之间的差异;再根据患者术后病理检查结果分为切缘阳性组和切缘阴性组进行单因素分析,将单因素分析中有意义的指标纳入多因素Logistic回归分析(逐步后退法)方法分析其危险因素。结果LEEP组的锥切面积、锥高、出血量均小于CKC组,差异有统计学意义(P<0.05)。单因素分析显示,两组患者的锥切面积、产次、手术方式、绝经状态、年龄具有显著性差异(P<0.05)。多因素Logistic回归分析(逐步后退法)显示,年龄(OR=1.07,95%CI:1.02-1.11)、LEEP(OR=2.95,95%CI:1.03-8.44)为高级别宫颈鳞状上皮内病变患者术后切缘阳性的危险因素,差异有统计学意义(P<0.05)。结论手术方式为LEEP、年龄是高级别宫颈鳞状上皮内病变术后切缘阳性的危险因素,在治疗过程中,为降低高级别宫颈鳞状上皮内病变患者术后切缘阳性率应对上述危险因素引起重视,采用合理方法降低相关风险。

Objective The postoperative medical records of patients with high-grade cervical squamous intraepithelial lesions undergoing cervical ring electroresection(LEEP)or cervical cold knife conization(CKC)were retrospectively analyzed,and the risk factors of positive postoperative margins were analyzed,which provided a reference for the treatment of patients with high-grade cervical squamous intraepithelial lesions.Methods Patients diagnosed with high-grade cervical intraepithelial neoplasia from January 1,2019 to December 31,2021 in the department of gynecology of a Grade A hospital in Urumqi were selected and divided into LEEP group and CKC group according to different surgical methods.Surgical indicators and margin positive rate of patients in the two groups were compared to analyze the differences between the two groups of surgical methods.According to the results of postoperative pathological examination,patients were divided into positive margin group and negative margin group for univariate analysis,and the significant indexes in univariate analysis were included in multivariate Logistic regression analysis(stepwise regression method)to analyze the risk factors.Results The cone cut area,cone height and blood loss of LEEP were significantly lower than those of CKC(P<0.05).Univariate analysis showed that there were significant differences in conical incision area,Production time,surgical method,menopausal status and age between the two groups(P<0.05).Multivariate Logistic regression analysis(stepwise regression method)showed that age(OR=1.07,95%CI:1.02-1.11)and LEEP(OR=2.95,95%CI:1.03-8.44)were the risk factors for positive postoperative margins in patients with cervical squamous intraepithelial lesion,with statistically significant differences(P<0.05).Conclusion The surgical method is LEEP and age are the risk factors for positive margin after high-grade cervical squamous intraepithelial lesion.In the treatment process,attention should be paid to the above risk factors in order to reduce the positive rate of postoperative margin in patients with high-grade cervical squamous intraepithelial lesions,and reasonable methods should be adopted to reduce related risks.