绝经后宫颈上皮内瘤变宫颈锥切术后病灶残留相关危险因素分析

Analysis of Risk Factors for Residual Lesions after Cervical Conization for Postmenopausal Cervical Intraepithelial Lesions

目的分析绝经后宫颈上皮内瘤变(CIN)患者行宫颈锥切术后病灶残留的相关危险因素。方法选取2017年3月至2020年8月于首都医科大学附属北京妇产医院妇瘤科门诊就诊行宫颈锥切术的253例绝经后CIN患者的临床资料进行回顾性分析,术后随访并记录病变残留相关情况。应用单因素及多因素Logistic回归模型分析患者分娩史、阴道镜活检结果、检查是否充分、锥切类型、锥切深度、锥切术后病理结果、切缘阳性与否、病变是否累及腺体以及锥切术后6个月人乳头瘤状病毒(HPV)感染状态与宫颈锥切术后病变残留的相关性。结果253例绝经后行宫颈锥切术CIN患者中,术后病灶残留26例,病灶残留率为10.28%。单因素分析结果显示,两组的锥切切缘及术后6个月HPV感染状态患者比例比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,锥切切缘阳性以及术后6个月HPV感染状态是绝经后宫颈病变锥切术后病灶残留的独立危险因素(P<0.05)。结论绝经后CIN锥切术后病灶残留的高危因素为宫颈锥切术后切缘阳性、术后6个月HPV感染状态。因此,应对绝经后CIN患者加强管理,密切随访,以早期发现病变残留。

Objective To analyze the risk factors of residual lesions after cervical conization in postmenopausal patients with cervical intraepithelial neoplasia(CIN).Methods The clinical data of 253 postmenopausal patients with CIN undergoing cervical conization in the Department of Gynecological Oncology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University from Mar.2017 to Aug.2020 were retrospectively analyzed.The patients were followed up and the residual lesions related information was recorded.Univariate and multivariate Logistic regression models were used to analyze the correlations of delivery,adequacy of colposcopy,biopsy results,conization type,depth,pathological results after conization,positive or negative cutting edge,involvement of glands and human papilloma virus(HPV)infection status 6 months after conization with residual lesions after cervical conization.Results Among the 253 patients,26 cases had residual lesions,and the incidence of residual lesions was 10.28%.Univariate analysis showed that there were significant differences between the two groups in the distribution of conization margin positive/negative and HPV infection status 6 months after operation(P<0.05).Multivariate Logistic regression analysis showed that the positive conization margin and HPV infection status 6 months after conization were independent risk factors for residual lesions after surgery on postmenopausal cervical lesions(P<0.05).Conclusion The high risk factors for residual lesions after cervical conization of postmenopausal CIN are positive margin and HPV infection at 6 months after surgery.Therefore,we should strengthen the management of postmenopausal patients with CIN and perform closely follow-up,in order to find the residual lesions early.