198例宫颈高级别上皮内病变患者锥切术后发生切缘阳性的高危因素分析

Analysis of Risk Factors for Positive Margins in 198 Patients with High-grade Cervical Intraepithelial Neoplasia after Cervical Conization

目的探讨宫颈高级别上皮内病变(HSIL/CIN2,HSIL/CIN3)行宫颈锥切术后病理切缘阳性的高危因素。方法通过回顾性分析因宫颈高级别上皮内病变行宫颈锥切术的198例患者的临床资料,应用单因素及多因素Logistic回归分析,探讨患者的年龄、孕次、产次、绝经情况、HPV感染型别、TCT结果、转化区类型、病变累及腺体、手术方式与切缘阳性之间的相关性。结果本研究共纳入198例患者,其中切缘阳性46例(23.23%),切缘阴性152例(76.77%)。单因素分析显示,TCT提示高级别病变(ASC-H或HSIL)、病变累及腺体、绝经状态、采用LEEP手术方式等差异有统计学意义(P<0.05);多因素Logistic回归分析显示,TCT提示高级别病变、病变累及腺体、绝经状态、采用LEEP手术方式均为宫颈锥切术后切缘阳性的高危因素(P<0.05)。结论宫颈高级别上皮内病变患者术前TCT提示高级别病变、病变累及腺体、绝经状态及采用LEEP手术方式均增加术后病理切缘阳性的风险。

Objective To explore high-risk factors of positive incisal margins in patients with high-grade cervical intraepithelial neoplasia after cervical conization.Methods The clinical data of one hundred and ninety-eight high-grade CIN(HSIL/CIN2,HSIL/CIN3)patients treated with cervical conization were retrospectively analyzed.The correlation between the age,gravidity,parity,menopausal status,HR-HPV genotype,ThinPrep cytologic test results,type of transformation zone,glandular involvement,conic resection method,and resection margin status were analyzed using univariate and multivariate logistic regression model.Results Of the 198 patients,the positive incisal margins in 46 cases(23.23%)were found,and there were152(76.77%)cases of negative margins.Univariate analysis showed that there were remarkable differences in ThinPrep cytologic test results,glandular involvement,menopausal status,conic resection method between positive margins and negative margins(P<0.05).The results of multivariate Logistic regression analysis showed that TCT results,glandular involvement,menopausal status and conic resection method were the high-risk factors of positive margins.Conclusion The HSIL TCT results,glandular involvement,menopausal status and performed loop electrosurgical excisional procedure(LEEP)are reliable predictors of positive margins after conization for high-grade CIN.