摘要
目的:探讨年轻HSIL患者行宫颈锥切术后病理升级的相关影响因素,以及不同手术方式的治疗价值比较,从而对有生育需求的妇女宫颈病变的管理及治疗提供指导。方法:对2014年1月-2020年6月在某院收治的宫颈活检病理诊断为高级别宫颈上皮内瘤变、年龄≤40岁且随访资料完整的128例患者进行回顾性研究。结果:128例HSIL患者锥切术后发生病理升级的比率达19.5%。多因素Logistic回归模型发现病灶累及位点数、病变累积腺体以及切缘阳性是影响术后病理升级的独立预后因素(P<0.05)。LEEP和CKC术在年轻患者治疗HSIL上疗效相当。病灶范围大小是影响手术方式选择的重要因素(P=0.229);而有无生育史、是否感染高危HPV、术前TCT检查结果、是否进行阴道镜检查均不影响治疗方式的选择,组间无统计学差异(P>0.05)。结论:年轻HSIL患者将宫颈环形电切术作为治疗CIN及保留生育功能的首选方案。病灶累及位点数、病变累积腺体以及切缘阳性是影响锥切术后病理升级的独立风险因素,充分术前评估,是减少二次手术的重要手段。病理升级后再次评估病灶范围、浸润深度、有无脉管浸润以及切缘状况可为选择后续治疗策略提供依据。
Objective:To explore the influencing factors of the upgraded pathological results after cervical conization in young HSIL patients,and to compare the therapeutic effect of different surgical approaches,thus to provide guidance on the management and treatment of cervical lesions in women with fertility needs.Methods:A retrospective study was performed on 128 patients with cervical biopsy pathological diagnosis as HSIL,age≤40 years and with complete follow-up data,who were admitted to a hospital from January 2014 to June 2020.Results:The rate of pathological upgrading in 128 patients with HSIL after conization was 19.5%.Multivariate Logistic regression model showed that the number of lesion involvement sites,lesion accumulation glands,and positive incision margins were independent prognostic factors influencing postoperative pathological upgrading(P<0.05).LEEP and CKC had comparable efficacy in the treatment of young patients with HSIL.Lesion extent was an important factor influencing the surgical approach(P=0.229),while the presence of fertility history,high-risk HPV infection,preoperative TCT results,and whether colposcopy was performed did not affect the choice of treatment method,and there was no statistical difference between the two groups(P>0.05).Conclusion:Cervical circular electrosurgical excision is the good choice for the treatment of CIN and the preservation of reproductive function in young patients with HSIL.The number of lesions involvement sites,lesion accumulation glands and positive margin are independent risk factors affecting the pathological upgrading after conization.Full preoperative evaluation is an important mean to reduce secondary surgery.Re-evaluation of the extent of the lesion,the depth of infiltration,the presence of vascular infiltration,and the status of the margins after pathological upgrading can provide a basis for selecting subsequent treatment strategy.
作者
熊艳
卢玉兰
张帆
李蓁
Xiong Yan;Lu Yulan;Zhang Fan;Li Zhen(Department of Gynecology Oncology,Zhongnan Hospital of Wuhan University,Hubei Oncology Medicine Clinical Research Center,and Hubei Key Laboratory of Tumor Biology and Behavior,Wuhan 430071)
出处
《数理医药学杂志》
CAS
2022年第5期693-697,共5页
Journal of Mathematical Medicine
关键词
宫颈上皮内瘤变
宫颈冷刀锥切
宫颈环形电切
复发
预后
临床效果
cervical intraepithelial neoplasia
cervical cold knife conization
cervical circular electrosurgical excision
recurrence
prognosis
clinical effect