育龄期妇女宫颈上皮内瘤变锥切治疗后切缘阳性的高危因素分析

Analysis of the risk factors in cutting edge positive after taper cutting treatment of the childbearing age women cervical intraepithelial neoplasia

目的探讨宫颈环形电切术(LEEP)及宫颈冷刀锥切术(CKC)治疗育龄期妇女宫颈上皮内瘤变(CIN)后切缘阳性的高危因素。方法回顾2007年1月～2011年11月在我院经阴道镜活检初步诊断为CIN(包括CIN1,CIN2,CIN3)的患者265例,年龄30～49岁,经宫颈锥切治疗后,切缘阳性者32例,切缘阴性者233例,随访1年,于术后6个月、12个月复查TCT,HPV,必要时行阴道镜、活检及进一步手术治疗。结果切缘阳性组年龄明显大于切缘阴性组(P<0.05);切缘阳性组的HPV负荷量明显高于切缘阴性组;切缘阳性组的术前TCT结果以HSIL(上皮内高度病变)为主,与切缘阴性组有统计学差异(P<0.05);病变累及腺体者的百分比在两组无明显差异(P>0.05),诊断CIN的级别,诊断CIN3者在切缘阳性组明显多于切缘阴性组(P<0.05)。结论育龄期妇女的年龄(≥40岁)、HPV负荷量(≥500)、TCT病变程度(≥HSIL)、诊断高级别CIN(CIN3)是CIN切缘阳性的高危因素。切缘阳性与病变复发/持续有关。在术前,对这部分高危患者安排有经验的医生进行,手术时谨慎操作,结合患者生育情况适当扩大手术范围,如果各种原因导致再次锥切不可能时,CIN3切缘阳性的患者可行子宫全切术,对于要求保留生育功能的患者应严密随访。

Objective To investigate the effect of LEEP and cervical cold knife conization （CKC） for treatment of women of childbearing age of cervical intraepithelial neoplasias after margin risk factors of positive. Methods A retrospective in 2007 January to 2011 November in our hospital were diagnosed by colposcope CIN （including CIN1, CIN2, CIN3） in 265 cases of patients, aged between 30 to 49 years old, after cervical conization after treatment, 32 cases with positive margin, 233 cases with negative margins, follow-up of 1 years, after June, December review of TCT, HPV, if necessary, colposcopy, biopsy and further operation treatment. Results The positive margin group was significantly greater than the negative margin group （P 〈 0.05）. HPV load margin positive group was significantly higher than negative margin group; positive margin group in the preoperative TCT results in HSIL （HSIL）, there was significant difference with negative margin group （P 〈 0.05）; lesions gland involvement in the percentage of no significant difference between the two groups （P 〉 0.05）, diagnosis of CIN level, the diagnosis of CIN3 in positive margin group were significantly more than negative margin group （P 〈 0.05）. Conclusion High HPV load of women of child-bearing age （ t〉 500）, higher severity of TCT （ I〉 HSIL）, diagnosis of high level CIN （ ~〉 CIN3） is the CIN margin risk factors of positive. Positive margin and tumor recurrence/continued. Before the operation, have experience on the part of patients at high risk for arrangement of the doctor, careful operation, combined with appropriate to expand the scope of operation planning situation, if all causes again conization is not possible, GIN3 patients with positive margin feasible uterus hysterectomy, patients for fertility preservation should be followed up closely.