【摘要】：目的宮頸上皮內(nèi)瘤變(cervical intraepithelial neoplasia,CIN)是與宮頸浸潤癌密切相關(guān)的一組癌前期病變。宮頸錐切術(shù)已成為CIN患者首選的治療方法,手術(shù)病理切緣陽性是宮頸錐切術(shù)后病變復(fù)發(fā)的危險因素。本研究通過對接受宮頸冷刀錐切術(shù)(cold knifecone,CKC)或環(huán)形電切除術(shù)(loop electrosurgical excision procedure,LEEP)的CIN患者進(jìn)行回顧性分析,探討造成宮頸錐切術(shù)切緣陽性的原因,旨在降低切緣陽性率。方法回顧性分析沈陽市婦嬰醫(yī)院2013-01-01-2014-12-31經(jīng)陰道鏡宮頸活檢診斷為CIN并接受宮頸錐切術(shù)471例患者,對患者年齡、是否絕經(jīng)、HPV感染、病變范圍、手術(shù)方式、病變級別和術(shù)后病理提示宮頸上皮腺體受累等7種因素與宮頸錐切術(shù)后切緣陽性率做相關(guān)性分析。結(jié)果 471例宮頸錐切術(shù)患者中63例術(shù)后病理提示切緣陽性,陽性率為13.38%。單因素分析結(jié)果顯示,宮頸錐切術(shù)后切緣陽性與HPV感染(χ~2=8.470,P0.05)、手術(shù)方式(χ~2=8.851,P0.01)、病變級別(χ~2=9.842,P0.05)及宮頸上皮腺體受累(χ~2=3.560,P0.05)有關(guān),與患者年齡(t=1.293,P0.05)、是否絕經(jīng)(χ~2=0.204,P0.05)及病變范圍(χ~2=0.498,P0.05)無關(guān)。多因素Logistic回歸分析顯示,HPV感染、LEEP和宮頸高級別病變是CIN錐切術(shù)后切緣陽性的危險因素。其中HPV感染因素,與HPV陰性組比較,HPV低危和高危組OR值分別為2.611(95%CI為1.214~5.615)和2.338(95%CI為1.100~4.968);病變級別因素,與CINⅠ比較,CINⅡ、CINⅢ和早期宮頸癌組OR值分別為7.903(95%CI為1.046~29.725)、27.852(95%CI為4.131~86.835)和21.548(95%CI為1.373~124.877)。結(jié)論 HPV感染、LEEP及CIN高級別病變是造成宮頸錐切術(shù)切緣陽性的高危因素,在CIN制定宮頸錐切手術(shù)方式時應(yīng)予以重視。
[Abstract]:Objective: cervical intraepithelial neoplasia (cervical intraepithelial neoplasia cin) is a group of precancerous lesions closely related to invasive cervical carcinoma. Cervical conization has become the first choice in the treatment of cin patients. The positive margin of operation and pathology is the risk factor for recurrence of cervical conization. The purpose of this study was to investigate the causes of positive margin of cervical conization by retrospective analysis of cin patients undergoing cold knifecone conization or (loop electrosurgical excision procedure LEEP. The purpose of this study was to reduce the positive rate of incisal margin. Methods retrospective analysis was made on 471 patients with cin diagnosed by colposcopy cervical biopsy in Shenyang Gynecological and infantile Hospital 2013-01-01-2014-12-31. The age of the patients, whether or not they were infected by HPV, the extent of the lesion, and the operation methods were analyzed. The grade of lesion and postoperative pathology showed that there were 7 factors related to cervical epithelial gland involvement and the positive rate of incisal margin after conization of cervix. Results among 471 cases of cervical conization, 63 cases showed positive margin after operation, and the positive rate was 13.38%. Univariate analysis showed that the positive margin of cervical conization was associated with HPV infection (蠂 ~ 2 / 2 / 8.470 / P 0.05), surgical method (蠂 ~ (2 / 2) = 8.851 / P ~ (0.01), grade of lesion (蠂 ~ (29) / 842 / P ~ (0.05) and cervical epithelial gland involvement (蠂 ~ (2 +) = 3.560), but had no relationship with age (t = 1.293), menopause (蠂 ~ (2) = 0.204 / 0) and lesion range (蠂 ~ (22) 0.498P ~ (0.05), and was not associated with age (t = 1.293), menopause (蠂 ~ (2) = 0.204) and lesion range (蠂 ~ (20.498) P 0.05). Multivariate logistic regression analysis showed that the infection of HPV and high grade lesions of cervix were the risk factors of positive margin after cin conization. The OR values of low risk and high risk groups were 2.611 (95 CI = 1.2145.615) and 2.338 (95 CI = 1.100 鹵4.968), and the OR values of cin 鈪，

本文編號：2118800