高级别宫颈上皮内瘤变宫颈锥切术后病灶残留的相关因素分析

Analysis of the related factors of residual lesions after cervical conization for high-grade cervical intraepithelial neoplasia

目的:了解高级别宫颈上皮内瘤变(CIN)宫颈锥切术后病灶残留状况及相关影响因素,探讨宫颈锥切术后需要补充手术的必要性。方法:通过回顾性分析因高级别宫颈上皮内瘤变(CINⅡ~Ⅲ)行宫颈锥切术,术后1个月即入院再次行全子宫切除手术的200例病人,通过单因素及logistic回归模型分析探讨年龄、孕产史、HR-HPV基因型、CIN分级、锥切方式、切缘状态与病灶残留之间的相关性。结果:200例病人中,98例(49.0%)子宫切除标本中有残留病变,年龄、产次、锥切方式与术后病灶残留之间无相关性;CIN分级、术前HPV-16或HPV-18阳性、切缘状态与病灶残留呈正相关,logistic回归分析发现CIN分级、切缘阳性和16/18型HPV检测结果均为病变残留的高危因素。结论:CIN分级、切缘阳性和术前HPV-16或HPV-18基因型阳性是高级别CIN行锥切术后病灶残留的可靠预测因子。

Objective:To investigate the residual status and related factors of lesions after conization of high-grade cervical intraepithelial neoplasia(CIN),and explore the necessity of supplementary surgery after conization.Methods:The clinical data of 200 high-grade CIN(CINⅡ-Ⅲ)patients treated with conization and total hysterectomy one month after surgery were retrospectively analyzed.The correlation between the age,pregnancy history,HR-HPV genotype,CIN grade,conic resection method,resection margin status and residual lesions were analyzed using univariate and logistic regression model.Results:Of the 200 patients,the residual lesions in the hysterectomy specimens in 98 cases(49.0%)were found,and there was not correlation between the age,birth rate,coning method and postoperative residual lesions.The CIN grade,positive preoperative HPV-16 or HPV-18 and margin status were positively correlated with the residual lesions.The results of logistic regression analysis showed that the CIN grade,positive margin and HPV-16 or HPV-18 test results were the high risk factors of residual lesions.Conclusions:The CIN grade,positive margin and preoperative HPV-16 or HPV-18 genotype are the reliable predictors of residual lesions after conization for high-grade CIN.