子宫颈上皮内瘤变3级患者行环形电刀切除术锥切术后切缘阳性及病变残留的相关因素分析

Risk factors of positive margins and residual lesions following LEEP conization in CIN3 patients

回顾性分析2017—2019年在徐州医科大学附属医院采用环形电刀切除术(LEEP)锥切术治疗子宫颈上皮内瘤变3级(CIN3)的380例患者临床资料。LEEP锥切术后112例(29.5%)切缘阳性,单因素及多因素logistic回归分析显示,切缘阳性及病变残留的相关因素为高危型人乳头状瘤病毒(HR-HPV)阳性(OR=4.92,95%CI:1.81~13.36)、子宫颈薄层液基细胞学检查(TCT)高级别病变(OR=3.95,95%CI:2.42~6.42)、累及腺体(OR=3.58,95%CI:1.93~6.63);169例因随访困难、无生育要求的患者锥切后切除子宫,其中51例(30.2%)提示病变残留,病变残留的危险因素是切缘阳性(OR=2.83,95%CI:1.44~5.59)。HR-HPV阳性、TCT高级别病变、累及腺体是CIN3患者LEEP锥切术后切缘阳性的相关因素,切缘阳性是病变残留的相关因素,需予重视。

The clinical data of 380 patients undergoing loop electrosurgical excision procedure(LEEP)conization for cervical intraepithelial neoplasia grade 3(CIN3)at the Affiliated Hospital of Xuzhou Medical University from January 2017 to December 2019 were retrospectively analyzed.Univariate and multivariate logistic regression analyses were used to determine the risk factors of positive margin and residual lesions following conization.One hundred and twelve cases(29.5%)had positive margins,and the risk factors for positive margins were positive high-risk human papillomavirus(OR=4.92,95%CI:1.81-13.36),high-grade lesions on thin cytologic test(TCT)screening(OR=3.95,95%CI:2.42-6.42),and glandular involvement(OR=3.58,95%CI:1.93-6.63).The hysteretomy was performed following conization in 169 hundred and sixty-nine patients who had difficulty in follow-up or no fertility intension,among whom 51(30.2%)had residual lesions;logistic regression analysis showed that positive margins on LEEP were a risk factor for residual lesions at the time of hysterectomy(OR:2.83,95%CI:1.44-5.59).The study indicates that positive HR-HPV,high-grade TCT lesions,and lesions involving glands are risk factors for positive margins in CIN3 patients undergoing LEEP conization;and positive margins is risk factor for residual lesions following conization,to which more attention should be paid in clinical practice.