248例宫颈上皮内瘤变患者宫颈环形电切术后复发的相关危险因素分析

Analysis of recurrent risk factors after cervical loop electrical excision procedure in 248 patients with cervical intraepithelial neoplasia

目的探讨宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)患者行宫颈环形电切术(loop electrical excision procedure,LEEP)治疗后复发的相关危险因素。方法回顾性分析2010年6月至2012年1月江苏盛泽医院行LEEP术治疗248例CIN患者临床资料,于术后6、12、18、24个月门诊复查阴道镜、液基薄层细胞学(thin-preparation cytologic test,TCT)与高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)负荷状态,进行单因素分析与多因素Logistic回归分析处理数据资料。结果单因素分析结果发现,术前CIN病理级别(CINⅢ)、HR-HPV持续高负荷状态、标本切缘阳性及宫颈腺体受累及与CIN患者术后复发显著相关;多因素Logistic回归分析结果表明,HR-HPV持续高负荷状态、标本切缘阳性、宫颈腺体受侵犯是CIN患者LEEP术复发的独立危险因素。结论 HR-HPV持续高负荷状态、手术标本切缘阳性及腺体受累是CIN术后复发的高危因素,对CIN患者LEEP术复发有较高临床预测价值。

Objective To study recurrent risk factors after cervical loop electrosurgical excision （LEEP） procedure in patients with cervical intraepithelial neoplasia （CIN）. Methods The clinical data of 248 CIN patients treated by LEEP in Shengze hospital of Jiangsu from June 2010 to January 2012 were retrospectively analyzed. The patients were followed up as long as 24 month after LEEP. Colposcope, thin-prep cytology test and high-risk human papillomavirus （HR -HPV） were performed at the sixth,twelfth, eighteenth, and twenty -forth month after LEEP. Univariate analysis and muhivariable logistic regression analysis were used to analyze the data. Results The result of univariate analysis showed that the preoperative pathology grade, high HPV - DNA load, positive margin of conization specimen and lesions involving cervical gland were significantly related to postoperative recurrence of CIN. The result of multivariate logistic regression analysis showed that high HR - HPV load, positive margin of conization specimen and lesions involving cervical gland were the independent dangerous factors leading to postoperative recurrence of CIN. Conclusion The high HR - HPV load, positive margin of conization specimen and lesions involving cervical gland were the high dangerous factors that lead to recurrent CIN ,which had high clinic predictive value of recurrence after LEEP.