切缘阳性的CINⅢ级患者后继治疗的选择

Subsequent treatment of choice for CINⅢ patients with positive margins

目的探讨切缘阳性的宫颈上皮内瘤变Ⅲ级(CINⅢ)患者后继治疗方式的选择,以及分析切缘阳性的影响因素对患者的重要作用。方法比较78例非保守组与150例保守组宫颈内、外切缘阳性患者的组织病理学结果,同时,将保守组中切缘阳性患者的影响因素进行单因素和多因素分析。结果①非保守组中,宫颈内外切缘阳性的患者发生残余病灶率比较差异有统计学意义(P=0.015)。保守组中,宫颈外切缘阳性和宫颈内切缘阳性的患者复发率比较,差异有统计学意义(P=0.038)。非保守组与保守组,宫颈外切缘阳性与宫颈内切缘阳性患者复发率比较差异有统计学意义(P=0.037)。②保守组中,单因素分析:是否绝经、宫颈外观、不同手术方式的切缘阳性率比较,差异均有统计学意义。结论密切随访的宫颈外切缘阳性的CINⅢ患者可仅行宫颈锥切术;绝经后、宫颈病变严重程度、宫颈环形电切术(LEEP)是宫颈切缘阳性的高危因素。

Objective To explore the subsequent treatment of choice for cervical intraepithelial neoplasia grade Ⅲ（CINⅢ） patients with positive margins, and analyze the important role of positive margin impact of factors on the patients. Methods The cervical histopathologie findings of exocervical margins and positive endoeervieal margins were compared in the 78 cases of noneonservative treatment group and 150 cases of conservative treatment group. At the same time, patients with positive margins impact of factors were analyzed by univariate and multivariate logistic analyzes in conservative group, Results In nonconservative treatment patients, compared the residual disease rate of patients with positive exocervical margins and positive endocervical margins, the differences were statistically significant （P = 0. 015 ）. In conservative treatment group, compared the relapse rate of patients with positive exocervical margins and positive endocervical margins, the differences were statistically significant （ P = 0. 038 ）. Compared the recurrence rate of two groups patients with positive exocervical margins and positive endocervical margins, the differences were statistically significant （ P = 0. 037 ）. In conservative group, compared positive margin rate of menopause, cervical appearance, different surgical methods, the differences were statistically significant. Conclusion Conservative treatment can be safely used in patients with positive exocervical margins of close followup. Menopause, cervical appearance, different surgtcal methods are positive margins highly relevant factors. Postmenopausal, the grade of serious cervical lesions, LEEP is high risk factors in patients with positive margins.