宫颈上皮内瘤变锥切术后复发的相关危险因素分析

Risk factors for the recurrence of cervical intraepithelial neoplasia after cervical conization

目的分析宫颈上皮内瘤变(CIN)患者宫颈锥切术后复发的相关危险因素。方法回顾性分析安溪县妇幼保健院2016年1月至2022年12月收治的高级别CIN患者(CIN ≥Ⅱ级)205例的临床资料,均接受环形电外科切除术(LEEP)或冷刀锥切术(CKC)。采用单因素和多因素风险模型分析术后复发的相关危险因素。结果 205例CIN的患者单因素分析中足月出生次数(HR=1.512,95%CI:1.191~1.920,P<0.05)、早产史(HR=7.255,95%CI:2.645~19.900,P<0.05)、流产史(HR=2.158,95%CI:1.273~3.660,P<0.05)、切缘状态阳性(HR=1.724,95%CI:1.092~2.720,P<0.05)、锥切长度(HR=0.953,95%CI:0.918~0.989,P<0.05)、宽度(HR=0.924,95%CI:0.800~0.975,P<0.05)、深度(HR=0.390,95%CI:0.285~0.535,P<0.05)、吸烟史(HR=2.143,95%CI:1.264~3.634,P<0.05)、合并症史(HR=3.392,95%CI:2.022~5.691,P<0.05)差异有统计学意义,Cox多因素风险模型提示切缘阳性(HR=2.144,95%CI:1.317~3.492,P<0.05)、早产史(HR=4.515,95%CI:1.598~12.754,P<0.05)、并发症史(HR=3.552,95%CI:1.952~6.462,P<0.05)是宫颈锥切术后复发的独立危险因素。结论宫颈锥切术后的高级别CIN患者,切缘阳性、早产史和合并症与复发风险增加相关,但锥切深度(> 0.5 cm)与复发风险较低相关。

Objective To analyze the relevant risk factors for recurrence of cervical intraepithelial neoplasia(CIN)in patients undergoing cervical conization.Methods The clinical data of 205 patients with high-grade CIN(CIN≥II)who received treatment in Anxi County Maternal and Child Health Hospital from January 2016 to December 2022 were retrospectively analyzed.All of these patients received loop electrosurgical excision procedure or cold knife conization.The relevant risk factors for CIN recurrence were analyzed using univariate and multivariate risk models.Results Univariate analysis results showed that there were significant differences in the number of full-term births(HR=1.512,95%CI:1.191-1.920,P<0.05),history of premature birth(HR=7.255,95%CI:2.645-19.900,P<0.05),history of miscarriage(HR=2.158,95%CI:1.273-3.660,P<0.05),positive surgical margins(HR=1.724,95%CI:1.092-2.720,P<0.05),conization depth(HR=0.953,95%CI:0.918-0.989,P<0.05),history of smoking(HR=2.143,95%CI:1.264-3.634,P<0.05),and history of comorbidities(HR=3.392,95%CI:2.022-5.691,P<0.05)among the 205 included patients.Cox multivariate risk model indicated that positive surgical margins(HR=2.144,95%CI:1.317-3.492,P<0.05),history of premature birth(HR=4.515,95%CI:1.598-12.754,P<0.05),and history of comorbidities(HR=3.552,95%CI:1.952-6.462,P<0.05)were independent risk factors for recurrence of CIN after cervical conization.Conclusion In patients with high-grade CIN undergoing cervical conization,positive surgical margins,history of premature birth,and history of comorbidities are associated with an increased risk of CIN recurrence,while a conization depth of>0.5 cm is associated with a low risk of CIN recurrence.