LEEP治疗宫颈上皮内瘤变术后复发临床特征及影响因素研究

The characteristics and its influencing factors of recurrence of cervical intraepithelial neoplasia after operation in treatment by LEEP

目的分析超高频电波刀宫颈锥切(LEEP)治疗宫颈上皮内瘤变(CIN)术后复发的临床特征及影响因素。方法回顾性分析256例行LEEP治疗的CIN患者临床和病理学资料,定期复查确诊随访期间复发病例,采用单因素分析和多因素非条件Logistic回归分析模型进行分析。结果 256例术后检出复发55例,复发率为21.48%,复发病例术后人乳头瘤病毒(HPV)检测均为阳性,低危型向高危型转变率显著高于高危型向低危型转变率(P<0.05),复发后HPV阳性率和高危型HPV阳性率较术前高。复发后整体病变程度有所减轻,但术前病变程度与复发病变程度呈正相关(r=0.398,P<0.05)。年龄、吸烟、绝经、高危型HPV感染、病变程度、切缘情况、腺体累及、病变象限累及数目均与CIN患者锥切术后复发有关(P均<0.01)。高危型HPV感染、病变程度、切缘情况及腺体累及是CIN患者锥切术后复发的独立危险因素(P均<0.01)。结论 CIN患者LEEP术后复发率及复发后高危型HPV检测阳性率较高,高危型HPV感染、病变程度、切缘情况及腺体累及是CIN患者复发的独立危险因素。

Objective To study the clinical characteristics and influencing factors of cervical intraepithelial neoplasia （CIN） patients after ultra-high frequency radiosurgical knife conization （LEEP） relapsed treatment. Methods Retro- spective analysis 256 patients with CIN detailed routine clinical and pathological data, periodic review confirmed re- currence during follow-up, used univariate analysis and multivariate conditional Logistic recalling model analysis. Re- sults The 256 cases were detected in 55 cases of recurrence, the recurrence rate was 21.48%,postoperative recurrent cases were positive for HPV testing,low-risk to high-risk transformation was significantly higher than high-risk to low- risk transition rate （P〈0.05）, relapse rate and high-risk HPV-positive rate of HPV-positive compared with preoperative high. Overall severity of recurrence had been reduced, but the severity and recurrence of preoperative severity was pos- itively correlated （r=0.398,P〈0.05）. Age, smoking, menopause, preoperative high-risk HPV infection, severity, margin status,glandular involvement,lesions involving all quadrants were related to CIN recurrence after conization （P〈0.01）. Menopause, preoperative high-risk HPV infection, severity, margin status and glandular involving were the independent risk factors for CIN recurrence after conization （P〈0.01）. Conclusion CIN patients after conization recurrence rate and high-risk HPV infection positive rate after conization are higher, menopause, preoperative high-risk HPV infection, severity, margin status and glandular involvement are CIN independent risk factors for relapse.