切缘阴性宫颈锥切术后影响宫颈上皮内肿瘤残留/复发的因素

Factors affecting residual / recurrent cervical intraepithelial neoplasm after conization of cervix with negative cervical margin

目的为明确影响切缘阴性的宫颈锥切术后患者宫颈上皮内肿瘤残留/复发的因素。方法选取2013年1月至2018年6月江苏大学附属四院暨镇江市妇幼保健院在诊治的250例经组织学证实的高级别鳞状上皮内病变患者作为研究对象。随访包括临床检查、液基细胞学检查、人乳头状瘤病毒(HPV)检测、阴道镜检查,必要时行阴道镜活检。用Kaplan-Meer方法分析平均复发时间,而用对数检验和Cox回归模型确定残留/复发CIN的预测因子。结果在87名切缘阴性的患者中确认了8例残留/复发的病例(9.2%)。在单因素分析中,后续的细胞学检查异常(P<0.001),锥切方法(P=0.017),HPV阳性(P<0.001),HPV感染后持续感染(P<0.001),相同基因型HPV持续感染(P<0.001),HPV锥切术后18个月阳性(P<0.001),是残留/复发的预测因素。多因素分析的结果进一步揭示了术后HPV的持续感染(P=0.035)、锥切术后18个月HPV阳性(P=0.017),随访细胞学检查异常(P<0.001)会增加残留/复发CIN的风险。结论在随访期间,持续HPV感染或细胞学异常的患者存在残留/复发CIN的高风险,应进行密切监测。HPV感染者在术后18个月之内转为阴性的复发风险较低。

Objective To determine the factors influencing cervical intraepithelial tumor residual/recurrence in patients with negative margin afterconization of cervix.Methods 87 patients with histologically confirmed high-grade squamous intraepithelial lesions treated in the Fourth Affiliated Hospital of Jiangsu University from January 2013 to June 2018 were selected.Follow-up included clinical examination,liquid-based cytology,detection of human papillomavirus(HPV),colposcopy and,if necessary,colposcopic biopsy.The mean recurrence time was analyzed by Kaplan-Meer method,and the predictors of residual/recurrent CIN were determined by logarithmic test and Cox regression model.Results Eight residual/recurrent cases(9.2%)were identified in the 87 patients.In univariate analysis,the following cytological abnormalities(P<0.001),conization(P=0.017),HPV positive(P<0.001),persistent infection after HPV infection(P<0.001),persistent infection of the same genotype(P<0.001),and positive 18 months after conization(P<0.001)were predictors of residual/recurrent HPV infection.Multivariate analysis further revealed that persistent HPV infection(P=0.035),HPV positive 18 months after conization(P=0.017),and abnormal follow-up cytology(P<0.001)increased the risk of residual/recurrent CIN.Conclusions Patients with persistent HPV infection or cytological abnormalities have a high risk of residual/recurrent CIN during follow-up and should be closely monitored.The risk of recurrence of HPV infection within 18 months after surgery is low.