宫颈锥切术后切缘阳性相关因素及处理分析

Analysis of risk factors and management of positive margin after cervix conization

目的回顾性分析宫颈锥切术后切缘阳性患者的病例特点及诊疗经过,为其后续诊治提供依据。方法收集2017年1月~2019年6月因宫颈病变于潍坊市人民医院住院行宫颈锥切术者606例(术后病理示切缘阳性者107例),分析所有患者年龄、孕产史、是否绝经等临床因素及切缘阳性患者的补充治疗情况。结果①首次宫颈锥切术后病理提示切缘阳性者占总锥切手术患者的17.7%;切缘阳性补充治疗者占20.6%,补充治疗术后病理有病灶残留者占59.1%.②单因素分析结果显示,宫颈锥切术后切缘阳性与术前宫颈HPV感染情况、宫颈活检病理级别因素有关(χ^2=12.806,P<0.05;χ^2=33.691;P<0.05)。③多因素Logistic回归分析结果显示,宫颈HPV16,18型感染和活检病理提示浸润癌这两个因素是宫颈锥切术后切缘阳性的危险因素,其OR值分别为2.006(95%CI为1.206-3.337)、22.446(95%CI为2.834-177.775)。结论宫颈锥切术后切缘阳性患者需个体化治疗,其中HPV16,18型感染和活检病理提示浸润癌为高危因素,需根据患者自身情况建议补充手术治疗。

Objective Retrospectively analyze the case characteristics and diagnosis and treatment of patients with positive margins after cervical conization,to provide a basis for the follow-up diagnosis and treatment of such patients.Methods A total of 606 patients who underwent cervix conization at the Weifang People’s Hospital for cervical lesions from January 2017 to June 2019(107 cases with positive resection margin after pathology)were enrolled.Analyze the clinical factors such as age,maternal history,menopause,etc.of all patients and the complementary treatment of patients with positive margins.Results①The rate of the positive margin in patients with cervix conization was 17.7%.Those who with positive margins of supplementary treatment accounted for 20.6%,and those who with residual pathology after supplementary treatment accounted for 59.1%.②Single factor analysis showed that the positive margin after cervix conization was related to HPV infection and the pathological grade of cervical biopsy before surgery(P<0.05).③The logistic regression analysis showed that cervical HPV16,18 infection and biopsy pathology suggest that invasive cancer was a risk factor associated with the positive margin,with OR values of 2.006(95%CI 1.206 to 3.337)and 22.446(95%CI 2.834 to 177.775).Conclusions Patients with positive margins after cervical conization need individual treatment.Among them,HPV16,18 infection and biopsy pathology suggested that invasive cancer were high-risk factor,and supplementary surgical treatment was recommended according to the patient’s own condition.