冷刀锥切术后宫颈高级别上皮内瘤变复发的影响因素

Risk factors for the recurrence of high-grade cervical intraepithelial neoplasia after cold-knife conization

目的探讨冷刀锥切术后宫颈高级别上皮内瘤变(HSIL)复发的影响因素。方法采用回顾性队列研究,对269例因HSIL行宫颈冷刀锥切术的患者进行分析。根据术前宫颈活检病理或术后病理结果,将患者分为HSIL累腺组(n=94)和非累腺组(n=175),随访开始时间为2015年7月,随访至2019年1月,终点事件为复发。构建2组生存曲线并比较差别,采用Cox回归分析探讨累腺、CIN等级、首诊年龄、初次性生活年龄、高危型人乳头瘤病毒(HPV)感染、宫颈受累范围对冷刀锥切术后复发的影响。结果Cox回归分析结果显示,CIN等级、首诊年龄、初次性生活年龄、高危型HPV感染、宫颈受累范围等因素对HSIL患者预后没有影响(P>0.05),而累腺是HSIL患者术后复发的危险因素(P<0.05),累腺组术后复发的风险是非累腺组的3.013倍。结论宫颈上皮内瘤变累腺是冷刀锥切术后复发的危险因素,会增加复发率。可以根据术前或术后病理结果,通过增加手术深度或加强随访降低复发风险。

Objective To investigate the risk factors for the recurrence of high-grade cervical intraepithelial neoplasia(HSIL)after cold-knife conization.Methods This retrospective cohort study included 269 patients who underwent cold-knife conization for HSIL.According to preoperative cervical biopsy or postoperative pathology,the patients were divided into the involving-gland group(n=94)and the non-involving-gland group(n=175).Follow-up spanned from July 2015 to January 2019.The outcome was recurrence,for which survival curves were constructed for comparison.Cox regression analysis was used to investigate the effects of factors such as the involving gland,CIN grade,age at first diagnosis,age at first sexual experience,high-risk human papilloma virus(HPV)infection,and cervical involvement range on recurrence after cold-knife conization.Results Cox regression analysis showed that CIN grade,age at first diagnosis,age at first sexual experience,high-risk HPV infection,and cervical involvement range had no effect on the prognosis of HSIL patients(P>0.05),while the involving gland was the risk factor for postoperative recurrence in HSIL patients(P<0.05).The risk of postoperative recurrence in the involving-gland group was 3.013 times higher than that in the non-involving-gland group.Conclusion The involving gland is a risk factor for recurrence after cold-knife conization,which increases the recurrence rate.According to pathology,the risk of recurrence can be reduced by increasing the surgical depth or perfect follow-up.