宫颈锥切术后切缘状态相关因素的分析

Analysis of the factors associated with conization margin status of the patients with cervical intraepithelial neoplasia III

目的评价宫颈上皮内瘤变III(CIN III)锥切术后边缘状态的相关因素。方法回顾性分析1999年1月1日至2004年12月31日我院收治的接受宫颈锥切术的CIN III患者361例,分析CIN III锥切术后边缘阳性与患者年龄、病变外观大小的关系,切缘阳性的处理及随诊情况。结果361例宫颈锥切术患者中,病例组58例(16.1%)切缘阳性,平均年龄(39.3±9.8)岁;对照组303例(83.9%)切缘阴性,平均年龄(37.1±7.4)岁(P=0.06)。两组的年龄无显著性差异。病例组中重度糜烂患者18例(31.0%),对照组中重度糜烂患者48例(15.8%),P=0.002。宫颈病变累及范围大,切缘阳性的可能性大。361例患者术后的随诊率为70%。术后宫颈细胞学检查的阳性率,切缘阳性者为21.4%,切缘阴性者为10.6%,无显著性差异(P=0.302)。结论宫颈锥切术后切缘的状态可能与肉眼病变累及宫颈的范围有关,对于切缘阳性的患者临床应严密随访。

Objective： To assess the factors associated intraepithelial neoplasia Ⅲ （CIN Ⅲ）. with conization margin status of the patients with cervical Methods. A retrospective analysis of 361 consecutive patients with CIN Ⅲ undergoing conization between Jan. 1^st 1999 and Dec 31^th 2004 was performed, to assess the relation of the positive margin of conization with the patient＇s age, size of lesion. The management and follow-up of the patients with the positive margins were evaluated. Results： For 361 patients who had their first conization, the mean age of 58 patients with positive margins was 39.3 years, and that of 303 negative margin patients was 37.1 years, which gave no much difference, P=0.06. The severe lesion of cervix was more in the patients with positive margins than in the patients with negative margins, P=0. 002. The rate of the follow-up was 70%. The rate of the abnormal cytology of follow-up in the patients with positive margin of conization （21.4%） was not significantly dif- ferent from that in the patients with negative margins （10. 6%）. Conclusions： The resection margin status of the conization may be related with the observed lesion of the cervix. The patients with CIN III should have a regular postoperative follow up, especially the patients with positive cone margin.