LEEP术后切缘阳性的高级别CIN绝经前患者病灶残留相关因素研究

Risk factors of residual lesions in premenopausal patients with high-grade cervical intraepithelial neoplasia of positive margins after LEEP

目的探讨LEEP术后切缘阳性的高级别子宫颈上皮内瘤变(CIN)绝经前患者病灶残留的相关因素,为进一步诊疗提供依据。方法收集初次LEEP术切缘阳性并行二次手术的51例高级别CIN、绝经前患者的临床资料,并对其病灶残留及相关因素进行分析。结果二次手术患者术后病理提示CIN共19例,其病灶残留率为37.2%。年龄≤35岁者病灶残留率为17.6%,年龄>35岁为47.1%,两者之间差异明显(P<0.05)。术前子宫颈脱落细胞(LBC)检测提示高度上皮内病变的病灶残留率明显高于低度上皮内病变组(P<0.05)。颈管搔刮物中提示病变存在者病灶残余率约72.7%,高于颈管搔刮物阴性者(P=0 006)。多因素logistic回归分析发现,LBC提示高度上皮内病变及颈管搔刮物阳性是与初次锥切切缘阳性病灶残留高度相关因素,其危险度分别为3.258、7.064。对51例二次手术患者随访至2013年6月,共2例复发,占3.92%。结论患者年龄、LBC结果及颈管搔刮物阳性与初次手术病灶残留有相关性,对于此类患者应予以高度重视。

Objective To investigate the risk factors of residual lesions in patients with high- grade cervical intraepithelial neoplasia （CIN） of positive resection margins after loop electrosurgical excision procedure（LEEP）. Methods The clinical data of 51 premenopausal patients with high- grade CIN undergoing LEEP from January 2007 to June 2012 at Affiliated Shaoxing Hospi-tal were retrospectively analyzed. Al patients had positive resection margins in initial conization and underwent second surgery. The risk factors of residual lesions were analyzed. Results Histopathological results of the second operation showed that 19 cases out 51 patients （37.2%） had residual disease. The residual disease rate in patients aged≤35 year was 17.6% , while in those〉35y was 47.1%（P35 years, LBC showing ASC- H and HSIL and endocervical curettage suggesting CIN are risk factors associat-ed with residual lesions in patients with high- grade CIN of positive margins after LEEP.