本文關(guān)鍵詞： 宮頸高級別病變 子宮頸癌 病理升級 預(yù)測因素 風(fēng)險(xiǎn)評估　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景及研究目的:宮頸浸潤癌在發(fā)病前要經(jīng)歷較長的癌前病變階段。研究表明CIN2-3患者有15%-30%病變將進(jìn)一步發(fā)展為子宮頸癌。近年來,隨著對子宮頸疾病的重視和篩查的普及,越來越多的患子宮頸疾病包括宮頸高級別病變及子宮頸浸潤癌的患者被早期發(fā)現(xiàn)。目前手術(shù)仍然是對宮頸高級別病變治療的主要方法,其中手術(shù)方式根據(jù)病變不同又有宮頸錐切術(shù)或子宮全切術(shù)。對宮頸高級別病變的患者切除子宮時(shí),存在有如下問題,若直接行子宮切除術(shù),約7%的患者術(shù)后病理結(jié)果最終被診斷為子宮頸癌,這就會(huì)出現(xiàn)手術(shù)范圍的不足,所以對于宮頸高級別病變患者行子宮切除術(shù)前,往往需要診斷性錐切。若診斷錐切常規(guī)病理結(jié)果回示病變升級,就需要擴(kuò)大手術(shù),行子宮切除術(shù),該過程中,患者及家屬焦慮,且感染機(jī)率增加,患肢經(jīng)歷多次手術(shù)麻醉,住院時(shí)間延長,這給患者和家屬帶來了較大的經(jīng)濟(jì)負(fù)擔(dān)和精神壓力,有學(xué)者主張采用術(shù)中診斷性錐切,行快速病理檢查,并根據(jù)冰凍結(jié)果立即行子宮切除術(shù)或擴(kuò)大手術(shù)范圍,這雖可避免上述弊端,但面臨冰凍結(jié)果不準(zhǔn)確,手術(shù)范圍不恰當(dāng)可能,仍面臨不恰當(dāng)手術(shù)風(fēng)險(xiǎn)。所以醫(yī)生需要在宮頸高級別病變患者住院時(shí)通過患者本身臨床特征及輔助檢查來判斷患者病理是否會(huì)升級,為宮頸高級別病變患者選擇合理的手術(shù)方式。本研究主要目的是,對預(yù)測宮頸高級別病變患者術(shù)后病理是否升級的相關(guān)因素進(jìn)行分析,對術(shù)后病理是否升級進(jìn)行評估,為合理選擇手術(shù)方式做參考。方法:收集2011年1月至2015年12鄭州大學(xué)第一附屬醫(yī)院因?qū)m頸高級別病變行宮頸錐切術(shù)患者臨床資料共2200例,對病例進(jìn)行整理后,發(fā)現(xiàn)陰道炎史、高危HPV感染史、宮頸轉(zhuǎn)化區(qū)、口服避孕藥、接觸性出血、結(jié)婚年齡、初產(chǎn)年齡、孕產(chǎn)次、MRI檢查結(jié)果、病變累犯點(diǎn)位數(shù)、年齡、吸煙史、非HPV感染的性傳播疾病(Sexually transmitted diseases,STD)13個(gè)因素完善患者病歷共1032例。統(tǒng)計(jì)這1032例患者宮頸錐切術(shù)后病理結(jié)果,根據(jù)結(jié)果的不同分為病理升級組和病理未升級組。并對各預(yù)測因素進(jìn)行單因素方差分析,取P0.05為差異有統(tǒng)計(jì)學(xué)意義,將有差異統(tǒng)計(jì)學(xué)意義的各因素進(jìn)行多因素二元logistic回歸分析,所有數(shù)據(jù)均采用SPSS 21.0軟件分析。結(jié)果:對這13個(gè)因素進(jìn)行分析,陰道炎史卡方值為0.954,p值為0.329;高危HPV感染卡方值為0.001,p值為0.985;口服避孕藥卡方值為7.176,p值為0.070;宮頸轉(zhuǎn)化區(qū)類型卡方值為86.219,p值為0.001;接觸性出血卡方值為0.073,p值為0.786;結(jié)婚年齡卡方值為0.580,p值為0.809;初產(chǎn)年齡卡方值為0.815,p值為0.367;孕產(chǎn)次卡方值為0.380,p值為0.538;MRI檢查結(jié)果卡方值為713.658,p值為0.001;病變累犯的點(diǎn)位數(shù)卡方值為28.984,p值為0.001;年齡卡方值為94.630,p值為0.001;吸煙史卡方值為6.713,p值為0.070;STD非HPV卡方值為9.299,p值為0.002。結(jié)果顯示宮頸轉(zhuǎn)化區(qū)類型、MRI檢查結(jié)果、病變累犯點(diǎn)位數(shù)≥3個(gè)、絕經(jīng)婦女、吸煙、非HPV感染的性傳播疾病(STD)這6個(gè)因素對結(jié)果影響存在差異(P0.05),將這6個(gè)因素進(jìn)行多因素二元logistic回歸分析后發(fā)現(xiàn)這六個(gè)因素均為預(yù)測術(shù)后病理結(jié)果升級的獨(dú)立危險(xiǎn)因素。結(jié)論:宮頸轉(zhuǎn)化區(qū)類型、MRI檢查結(jié)果、病變累犯點(diǎn)位數(shù)≥3個(gè)、絕經(jīng)婦女、吸煙、非HPV感染的性傳播疾病(STD)為預(yù)測宮頸高級別病變患者病理是否升級的獨(dú)立危險(xiǎn)因素,術(shù)前完善相關(guān)檢查,并對這些資料進(jìn)行收集,能提高對術(shù)后病理是否升級的預(yù)測的準(zhǔn)確性,對于臨床醫(yī)生制定手術(shù)方案具有一定的參考意義。
[Abstract]:Background: the stage of invasive cervical cancer after long before the onset of precancerous lesions. The research showed that CIN2-3 patients with 15%-30% lesions will develop into cervical cancer. In recent years, with the popularity of cervical diseases screening and attention, more and more patients with cervical diseases including high grade cervical lesions and invasive cervical cancer patients were found early. The surgery is still the main method for the treatment of high grade cervical lesions, including surgical methods according to different pathological changes and cervical conization or hysterectomy for uterus. High grade cervical lesions in patients with hysterectomy, there are the following problems, if direct hysterectomy about 7% of the patients, the postoperative pathological results were diagnosed as cervical cancer, which will be the lack of scope of operation, so for high grade cervical lesions underwent hysterectomy before, often need to Diagnostic conization. If diagnostic conization pathological results were shown in the back to upgrade, we need to expand the surgery, hysterectomy, in this process, the anxiety of patients and their families, and the infection rate increased, limb anesthesia times, prolonged hospitalization, which has brought great economic burden and mental stress to patients and their families, some scholars advocate the use of intraoperative diagnostic conization for pathological examination, and immediately hysterectomy or expand the extent of surgery according to the results of frozen section, it can avoid the disadvantages, but face freezing results are not accurate, the scope of operation may be inappropriate, still faces inappropriate surgical risk. So the doctor needs to the patients clinical features and auxiliary examination in patients with high grade cervical lesions to determine whether patients with pathology will be upgraded, the reasonable selection of surgical approaches for patients with high-grade cervical lesions. The purpose of this study Is that the pathological factors related to whether to upgrade the prediction of cervical operation in patients with high level after the analysis of whether the postoperative pathological upgrade assessment, as a reference for reasonable selection of operation mode. Methods: the First Affiliated Hospital of Zhengzhou University from January 2011 12 to 2015 due to high grade cervical lesions cervical conization in patients with clinical data of a total of 2200 for example, case afterfinishing found vaginitis history, high-risk HPV infection, cervical transformation zone, oral contraceptives, contact bleeding, age of marriage, age at first birth, pregnancy, MRI examination, lesions recidivism point digit age, smoking history, sexually transmitted diseases, non HPV infection (Sexually transmitted diseases, STD 13) factors to improve patient records 1032 cases. Statistics of these 1032 patients after cervical conization pathology results, according to the different results of pathological and pathological upgrading group were not upgraded and the prediction group. 鍥犵礌榪涜鍗曞洜绱犳柟宸垎鏋，

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