探讨宫颈管搔刮术的适用条件

Exploring the applicability criteria of endocervical curettage

目的探讨宫颈管搔刮术(endocervical curettage,ECC)的适用条件。方法收集2021年1月至2023年5月华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)门诊宫颈液基薄层细胞学(thinprep cytology test,TCT)异常和/或人乳头瘤病毒(human papillomavirus,HPV)感染并已接受阴道镜下宫颈多点活检联合ECC的患者3999例,术后病理结果为金标准。回顾分析不同因素对ECC病理结果的影响,探究ECC的临床适用条件。结果单因素分析中年龄、孕次、TCT异常、HPV(16、18、31、33、52、58)单独感染对ECC病理结果有影响(P<0.05),转化区分型、是否绝经对ECC病理结果无影响(P>0.05);Logistic回归分析中年龄≥40、TCT异常、HPV(16、18、31、33、52、58)单独感染为ECC阳性结果的独立危险因素。多因素分层分析发现,TCT异常、无论年龄如何,HPV(16、18、31、33、52、58)单独感染组ECC阳性率均较HPV(低危+阴性)组差异有统计学意义;TCT正常,HPV16感染,年龄≥40岁ECC阳性率较年龄<40岁组有明显差异。结论HPV(16、18、31、33、52、58)单独感染合并TCT异常时,无论年龄如何,均建议行ECC;HPV16感染、TCT正常、年龄≥40岁建议行ECC。

Objective To investigate the appropriate conditions for the use of endocervical curettage(ECC).Methods This retrospective study included 3999 patients from Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science and Technology between January 2021 and May 2023,who had abnormal thinprep cytology test(TCT)results and/or human papillomavirus(HPV)infections.These patients underwent colposcopy-guided multiple cervical biopsies combined with ECC.Postoperative pathological results were used as the gold standard.Retrospective analysis the impact of various factors on ECC pathological outcomes and assessed the clinical applicability of ECC.Results Univariate analysis indicated that age,parity,TCT abnormalities,and specific HPV types(16/18/31/33/52/58)significantly influenced ECC pathological outcomes(P<0.05),while the transformation zone types and menopausal status did not(P>0.05).Logistic regression analysis identified age≥40,TCT abnormalities,and specific HPV types(16/18/31/33/52/58)as independent risk factors for positive ECC.Multivariate stratified analysis demonstrated that in patients with TCT abnormalities,the ECC positivity rate was significantly higher in the group infected with HPV types(16/18/31/33/52/58)compared to the low-risk or HPV-negative group,regardless of age.Among patients with normal TCT results,those aged≥40 with HPV16 infection had a significantly higher ECC positivity rate than those under 40.Conclusion ECC is recommended for patients with TCT abnormalities combined with HPV(16/18/31/33/52/58)infections,regardless of age.Additionally,ECC is advisable for patients aged≥40 with HPV16 infection and normal TCT results.