CKC治疗HSIL术后病灶残余或切缘阳性所致补充手术因素分析

Analysis of the factors related to supplementary surgery caused by residual or positive lesions in resection margin after cervical cold knife conization for treating the high-grade squamous intraepithelial lesion of cervix

目的:探究宫颈冷刀锥形切除术(CKC)治疗宫颈高度鳞状上皮内病变(HSIL)后病灶残余或切缘阳性危险因素。方法:回顾性分析2017年1月-2019年1月因HSIL在本院行CKC治疗的110例患者临床资料,根据是否因病灶残余或切缘阳性所致补充手术将患者分为补充手术组(n=29)和未补充手术组(n=81),探讨CKC治疗HSIL术后行补充手术相关因素。结果:补充手术组与未补充手术组产次>2次(58.7%、65.5%)、月经不规律(35.8%、43.2%)有差异(P<0.05)。高危HPV>2种、病理分型CIN III、转化区III型、累及腺体、累及象限>2及宫颈接触性出血占比(55.2%、69.0%、62.1%、58.6%、51.7%、62.1%)和(29.6%、45.7%、32.1%、37.0%、29.6%、40.7%)有差异(P<0.05)。两组HPV感染、柱状上皮异位程度占比无差异(P>0.05)。补充手术组初次锥切宽度≤15mm、初次CKC锥切体积≤2cm3占比均高于未补充手术组,切除深度低于未补充手术组(P<0.05)。经logistic多因素回归分析显示,高危HPV类型>2种、转化区III型、累及腺体、累及象限>2个、宫颈接触性出血、初次锥切宽度≤15mm、初次CKC锥切体积≤2cm3、切除深度是CKC术后病灶残余或切缘阳性所致补充手术的独立风险因素(P<0.05)。结论:临床对上述危险因素应引起足够重视。

Objective:To explore the risk factors of the residual or positive lesions in resection margin after cervical cold knife conization(CKC)for treating the high-grade squamous intraepithelial lesion(HSIL)of cervix.Methods:The clinical data of 110 patients who underwent CKC for treating their HSIL of cervix from January 2017 to January 2019 were analyzed retrospectively.These patients were divided into group A(29 patients with supplementary surgery)and group B(81 patients without supplementary surgery)according to whether they were given supplementary surgery caused by residual or positive lesions in resection margin.The related factors of supplementary surgery after CKC were explored.Results:There were significant different in the proportions of parity>2 times(58.7%vs.65.5%)and irregular menstruation(35.8%vs.43.2%)of the patients between the two groups.The proportions of the high risk HPV infection>2 types,the lesions of pathological classification with CIN III,the lesions of cervical transformation zone with CIN III,the lesions involved in glands,the lesions involved over 2 quadrants of cervix,and the cervical contact bleeding of the patients in group A were 55.2%,69.0%,62.1%,58.6%,51.7%,and 62.1%,respectively,which were significantly different from those(29.6%,45.7%,32.1%,37.0%,29.6%,40.7%,respectively)of the patients in group B(P<0.05).There were no significant differences in the proportions of HPV infection and the ectopic degree of cervical cylindrical epithelium of the patients between the two groups(P>0.05).The proportions of the primary cervical conical incision width≤15mm and primary conical incision volume by CKC≤2cm3 of the patients in group A were significantly higher than those of the patients in group B,but the primary cervical resection depth of the patients in group A was significantly less than that of the patients in group B(P<0.05).Logistic multifactor regression analysis showed that high-risk HPV infection>2 types,the lesions of cervical transformation zone with CIN III,the lesions involved in glands,the lesions involved more than two quadrants of cervix,the cervical contact bleeding,the primary cervical conical incision width≤15mm,primary conical incision volume by CKC≤2cm3,and the cervical resection depth of the patients were the independent risk factors of supplementary surgery caused by residual or positive lesions in resection margin after CKC(P<0.05).Conclusion:The risk factors of supplementary surgery caused by residual or positive lesions in cervical resection margin after CKC should be paid enough attention to in clinic.