影响宫颈锥切术治疗Ia1期宫颈癌预后的相关因素分析

Factors affecting the prognosis of cervical conization for the patients with stage IA1 cervical cancer

目的探讨影响宫颈锥切术治疗期宫颈癌预后的相关影响因素。方法Ia1选取2010年12月30日至2014年12月30日确诊为Ia1期宫颈癌并接受宫颈锥切术的患者60例,并根据患者术后有无病灶残余,将患者分为术后优良组和术后残余组。记录每位患者术后一般情况、病灶残余和复发情况,术后采用ZUNG焦虑/抑郁自评量表(SAS/SDS)评定患者的焦虑和抑郁情况。Logistic回归分析影响期宫颈癌手术预后的相关影响因素。结果 Ia1与术后优良组比较,术后残余组在年龄、绝经、BMI(体质量指数)、经阴分娩次数、吸烟和室外锻炼时间等差异均无统计学意义(P>0.05),而标本切缘状况和术后HPV(人乳头瘤病毒)感染两组间差异有统计学意义(P<0.01)。术后优良组患者SAS和SDS得分均低于术后残余组(P<0.01)。患者切缘情况、焦虑/抑郁和术后HPV感染是直接影响术后病灶残余的重要危险因素(P<0.05)。其中切缘情况对预后的影响程度最高,其次是术后感染、焦虑/抑郁等心理因素。结论HPV宫颈锥切术治疗Ial期宫颈癌患者术后预后状况与手术情况和患者心理因素等有关;通过提高手术质量和对患者进行心理疏导,可为改善宫颈锥切术预后情况提供临床参考。

Objective To study the factors affecting the prognosis of cervical conization for the patients with stage IA1 cervical cancer. Methods Sixty patients were diagnosed with Ial cervical cancer and received cervical conization from December 30, 2010 to December 30, 2014 were selected. The patients were divided into two groups according to whether the patients have lesion residue after operation, Postoperative Excellence Group and Postoperative Residue Group. The general condition, lesion residue and recurrence of each patient after operation are recorded. The anxiety and depression of the patients was evaluated by Zung self-rating anxiety and depressive scale （SAS/SDS）. Logistic regression analysis was used for the prognostic factors of cervical cancer in stage Ial. Results Compared with the Postoperative Excellence Group, Postoperative Residue Group showed no significant difference in the age, menopause, BMI, times of vaginal delivery, smoking and time for outdoor exercises （P〉0.05）. There was statistical difference in incisal edge of specimens and postoperative HPV infection （human papilloma virus） between the two groups （P〈0.01）. The patients in the Postoperative Excellence Group had a SAS and SDS score lower than Postoperative Residue Group （P〈0.01）. The incisal edge, anxiety/depression and postoperative HPV infections are important risk factors directly affecting the postoperative lesion residue （P〈0.05）, of which the incisal edge had the highest effect on prognosis, followed by postoperative HPV infection, anxiety/depression and other psychological factors. Conclusion The postoperative prognosis of the Ial cervical cancer patients receiving cervical conization is related to surgical conditions and psychological factors of patients, improving the quality of surgery and providing psychological counseling for the patients can provide a clinical reference for improving the prognosis of cervical conization.