宫颈上皮内瘤变锥切术后切缘阳性的相关危险因素及其复发情况分析

Analysis of related risk factors and recurrence of cervical intraepithelial neoplasia with positive margin after conization

目的探讨宫颈上皮内瘤变(CIN)锥切术后切缘阳性的相关危险因素及其复发情况。方法回顾性分析89例接受锥切术治疗的CIN患者的临床资料,按切缘情况将患者分为切缘阳性组(14例)和切缘阴性组(75例),分析CIN锥切术后切缘阳性的相关危险因素及其复发情况。结果单因素分析结果显示,切缘阳性组年龄≥60岁、人乳头瘤病毒(HPV)持续感染、宫颈中重度糜烂、宫颈上皮腺体受累、手术方式为宫颈环形电切除术(LEEP)和CINⅢ级率均高于切缘阴性组(均P<0.05);两组碘不着色区最大径、孕次、产次、BMI、吸烟史、饮酒史、宫颈癌家族史、手术时间、接触性出血情况比较,差异均无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示,年龄≥60岁、HPV持续感染、宫颈中重度糜烂、宫颈上皮腺体受累、手术方式为LEEP、CINⅢ级是影响CIN锥切术后切缘阳性的独立危险因素(均P<0.05)。术后随访6个月,切缘阳性组复发率为21.43%,高于切缘阴性组的1.33%(P<0.05)。结论宫颈上皮内瘤变锥切术后切缘阳性与多种因素密切相关,切缘阳性会增加术后复发率,临床应针对各危险因素加强防治,以改善患者预后。

Objective To investigate the related risk factors and recurrence of cervical intraepithelial neoplasia(CIN)with positive margin after conization.Methods The clinical data of 89 CIN patients treated with conization were retrospectively analyzed,and they were divided into positive margin(14 cases)and negative margin(75 cases)groups by the margin status to study the related risk factors and recurrence of positive margins after CIN conization and its recurrence.Results The result of univariate analysis showed that the rates of patients aging≥60 years old,with persistent human papilloma virus(HPV)infection,moderate to severe cervical erosion,cervical epithelial gland involvement,performed loop electrosurgical excisional procedure(LEEP)and with CIN gradeⅢin the positive margin group were higher than those in the negative margin group(all P<0.05).There were no statistically significant differences between the two groups in maximum diameter of iodine non-stained area,gravidity,parity,body mass index(BMI),smoking history,drinking history,family history of cervical cancer,operation time and contact bleeding(all P>0.05).Multivariate Logistic regression analysis showed that age≥60 years old,persistent HPV infection,moderate to severe cervical erosion,cervical epithelial gland involvement,treated with LEEP,and CIN gradeⅢwere independent risk factors for positive margin after CIN conization(all P<0.05).After 6 months of follow-up,the recurrence rate of positive margin group was 21.43%,which was higher than that of negative margin group(1.33%)(P<0.05).Conclusion The positive margin of CIN after conization is closely related to a variety of factors,and the positive margin will increase the postoperative recurrence rate.Therefore,prevention and treatment should be strengthened according to each risk factor to improve the prognosis of patients.