宫颈高级别上皮内瘤变锥切术后切缘阳性及再次手术病灶残留的危险因素分析

Analysis of risk factors of positive surgical margin and residual lesions after cone resection of high-grade intraepithelial neoplasia

目的分析宫颈高级别上皮内瘤变经锥切术后病理切缘阳性及再次手术后病灶残留的危险因素,指导临床工作及后期随访。方法回顾性分析内蒙古自治区人民医院2013年11月至2018年11月因宫颈上皮内瘤变Ⅱ、Ⅲ级行宫颈锥切术且符合条件、资料完整的患者180例的临床资料,对锥切术后切缘阳性及再次手术(包括再次锥切、子宫切除)病灶残留的相关危险因素采用单因素、多因素回归分析。结果锥切术后切缘阳性发生率为31.67%(57/180),切缘阳性再次手术病灶残留率为36.84%(21/57)。绝经、接触性出血、宫颈癌(原位癌、微小浸润癌)是切缘阳性危险因素(OR=2.342、2.428、8.949);接触性出血、宫颈癌(原位癌、微小浸润癌)是切缘阳性再次手术病灶残留危险因素(OR=5.370、10.992)。结论接触性出血、宫颈癌(原位癌、微小浸润癌)与宫颈切缘阳性及病灶残留密切相关,其中,绝经与切缘阳性有关,它们是影响宫颈锥切切缘阳性、再次手术病灶残留的危险因素,临床应高度重视。

Objective To analyze the risk factors of positive surgical margin and residual lesions after cone resection of high-grade intraepithelial neoplasia,and to guide clinical work and follow-up.Methods The clinical data of 180 patients with cervical epithelial neoplasia of gradeⅡandⅢwho underwent cervical conization in the People's Hospital of Inner Mongolia Autonomous Region from November 2013 to November 2018 were retrospectively analyzed.The risk factors associated with residual margin and reoperation(including re-cone and hysterectomy)after conization were performed by single factor and multivariate regression analysis.Results The incidence of positive resection margins after conization was 31.67%(57/180),which of the residual margin of re-surgery was 36.84%(21/57).Menopause,contact bleeding,cervical cancer(in situ carcinoma,microinvasive carcinoma)were positive risk factors for conical cutting margin(OR=2.342,2.428,8.949).Contact bleeding,cervical cancer(in situ carcinoma,microinvasive carcinoma)were risk factors for residual resection of the surgical margin after conization(OR=5.370,10.992).Conclusion Contact bleeding,cervical carcinoma in situ,microinvasive carcinoma are closely related to cervical margin and lesion residual.Among them,menopause is also positively related to margin,which is a risk factor affecting cervical cone cutting margin and residual reoperation.It should be highly valued in clinical.