两种锥切术式治疗宫颈高级别上皮内瘤变的疗效及术后复发因素的探讨

The effect of two kinds of conization in the treatment of high-grade cervical intraepithelial neoplasia and the influencing factors of the postoperative recurrence

目的对比宫颈环形电切术(Leep)与宫颈冷刀锥切术(CKC)治疗宫颈高级别上皮内瘤变(HSIL)的疗效,并探讨2种术式术后HSIL复发的影响因素。方法回顾性分析578例HSIL患者,根据术式不同分为Leep组及CKC组,每组各289例,比较2组手术切净率、术后复发率及术后不良妊娠发生率,并采用单因素分析与多因素Logistic回归分析研究可能影响HSIL术后复发的危险因素。结果2种术式术中病灶切净率的比较,Leep组85.1%,CKC组88.9%,2组相比差异无统计学意义(P>0.05);2种术式术后复发率的比较,Leep组13.5%,CKC组16.3%,2组相比差异无统计学意义(P>0.05);2种术式术后不良妊娠发生率的比较,Leep组27.5%,CKC组27.6%,2组差异无统计学意义(P>0.05);HSIL术后复发高危因素分析,578例患者术后随访3年,其中复发86例,单因素分析发现病变累及范围、是否累腺、切缘是否干净是HSIL术后复发高危因素;多因素logistic回归分析结果显示病变累及范围是HSIL术后复发的独立危险因素。结论Leep与CKC治疗HSIL疗效相当;病变累及范围、是否累腺、切缘是否干净是HSIL术后复发高危因素,而病变累及范围是复发的独立危险因素。

Objective To compare the efficacy of cervical ring electroresection(Leep)and cervical cold knife cone(CKC)in the treatment of high-grade cervical intraepithelial neoplasia(HSIL),and to explore the influencing factors of the postoperative recurrence.Methods A was performed on 578 patients with HSIL were retrospective analyzed and divided into Leep group and CKC group according to different surgical methods,with 289 cases in each group.The postoperative recurrence of the two groups was compared,and the univariate analysis and multivariate logistic regression were used to analyze the risk factors that might affect the postoperative recurrence of HSIL.Results There was no significant difference in the Intraoperative clear rate of lesions between the two groups(P>0.05),85.1%in the Leep group and 88.9%in the CKC group.There was no significant difference in the Postoperative recurrence rate between the two groups(P>0.05),13.5%in the Leep group and 16.3%in the CKC group.There was no significant difference in the incidence of adverse pregnancy between the two groups(P>0.05).578 patients were followed up for 3 years after surgery,of which 86 cases were relapsed,and the univariate analysis found that the risk factors for postoperative HSIL recurrence included the range of lesions involved,the glands involved and the cleanliness of the incision margin,the multivariate logistic regression analysis showed that the extent of lesion involvement was an independent risk factor for postoperative HSIL recurrence.Conclusions The efficacy of Leep and CKC in the treatment of HSIL is comparable.The range of lesions involved,the glands involved and the cleanliness of the incision marginextent are the high risk factors for recurrence after HSIL surgery.The extent of lesion involvement is an independent risk factor for postoperative HSIL recurrence.