宮頸上皮內(nèi)瘤變術(shù)后復(fù)發(fā)及殘留高危因素分析
發(fā)布時(shí)間：2018-09-16 21:48
【摘要】：宮頸上皮內(nèi)瘤變(CIN)是一組與子宮頸浸潤(rùn)癌的發(fā)生密切相關(guān)的子宮頸病變,該病變主要發(fā)生在25-35歲的婦女。低級(jí)別的CIN大部分是可以消退的,但高級(jí)別的CIN有癌變的可能,可以發(fā)展為浸潤(rùn)癌,被視為癌前病變。近年來(lái)CIN及宮頸癌的發(fā)病率在逐漸上升,而且發(fā)病的年齡也越來(lái)越趨向于年輕化。宮頸上皮內(nèi)瘤變病理分級(jí)分三級(jí):CIN1、CIN2、CIN3,其中CIN3包括重度不典型增生和原位癌,這三級(jí)反映了從宮頸病變發(fā)展成為宮頸癌的連續(xù)過(guò)程,從CIN發(fā)展成為宮頸癌大約需要10年的時(shí)間。所以做到CIN的早發(fā)、早診、早治可以降低宮頸癌的發(fā)病率。臨床上宮頸癌的診斷要遵循“三階梯”原則:即宮頸細(xì)胞學(xué)檢查、陰道鏡檢查和病理學(xué)檢查,病理學(xué)檢查是診斷宮頸癌的金標(biāo)準(zhǔn)。臨床對(duì)CIN的治療方法有激光治療、電凝治療、冷凍治療等,但傳統(tǒng)的方法創(chuàng)傷較大,患者術(shù)后并發(fā)癥發(fā)生率較高且易復(fù)發(fā),目前臨床上主要應(yīng)用宮頸環(huán)形電切術(shù)(LEEP)和冷刀錐切術(shù)(CKC)來(lái)治療宮頸上皮內(nèi)瘤變,有顯著的治療效果,但是仍有患者術(shù)后會(huì)復(fù)發(fā)。2013年美國(guó)陰道鏡及宮頸病理協(xié)會(huì)(ASCCP)宮頸癌篩查新指南推薦:對(duì)于組織學(xué)診斷為CIN2、CIN3者,不建議采用表面破壞治療,而推薦診斷性宮頸錐切術(shù),但術(shù)后會(huì)有1%-25%患者治療失敗。CIN治療失敗可能會(huì)導(dǎo)致CIN術(shù)后的復(fù)發(fā),也有發(fā)展為浸潤(rùn)癌的可能,所以,分析出宮頸錐切術(shù)后復(fù)發(fā)及殘留的高危因素,區(qū)分出CIN治療后復(fù)發(fā)的高�；颊�,這些患者術(shù)后要嚴(yán)密隨訪發(fā)現(xiàn)病變及時(shí)進(jìn)一步治療,可以達(dá)到早期預(yù)防CIN的復(fù)發(fā)的目的,這樣能有效的控制疾病的復(fù)發(fā)和進(jìn)展。本研究通過(guò)回顧性病例分析的方法,分析CIN患者臨床病理資料與CIN術(shù)后復(fù)發(fā)殘留之間的關(guān)系。目的:評(píng)估LEEP和CKC治療CIN的臨床療效,通過(guò)對(duì)兩種手術(shù)的術(shù)中出血量、術(shù)后并發(fā)癥及術(shù)后復(fù)發(fā)率等方面進(jìn)行比較,根據(jù)患者的病變級(jí)別為患者提供安全有效的治療方式,減少患者術(shù)后的復(fù)發(fā)殘留,提高患者的治愈率。分析CIN患者的臨床病理資料,研究CIN患者術(shù)后病變復(fù)發(fā)、殘留與患者年齡、孕次、產(chǎn)次、是否絕經(jīng)、術(shù)前病理分級(jí)、cin3病變點(diǎn)數(shù)(≥3)、宮頸糜爛樣改變程度、手術(shù)方式、術(shù)后病理切緣情況、腺體受累、術(shù)前及術(shù)后6個(gè)月hpv感染,scc、腫瘤家族史、吸煙及飲酒等因素之間的相關(guān)性,通過(guò)單因素多因素分析找出與cin患者術(shù)后復(fù)發(fā)及殘留相關(guān)的高危因素,區(qū)分出cin治療后容易復(fù)發(fā)的高�；颊�,對(duì)他們進(jìn)行嚴(yán)密的術(shù)后隨訪,若發(fā)現(xiàn)病變及時(shí)進(jìn)一步治療,以達(dá)到早期預(yù)防cin的復(fù)發(fā)的目的,有效的控制疾病的復(fù)發(fā)和進(jìn)展。材料與方法:收集大連醫(yī)科大學(xué)2012年6月-2014年12月收治的256例cin患者的臨床病理資料,使用spss19.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析,采用t檢驗(yàn)、pearsonx2檢驗(yàn)和logistic回歸分析等方法,回顧性分析leep和ckc在治療cin上的臨床療效,分析2種手術(shù)方式對(duì)cin的治愈率、術(shù)后復(fù)發(fā)率等方面的差異,通過(guò)單因素及多因素分析cin患者術(shù)后復(fù)發(fā)、殘留與患者的年齡、孕次、產(chǎn)次、絕經(jīng)、術(shù)前病理分級(jí)、cin3病變點(diǎn)數(shù)、宮頸糜爛樣改變程度、手術(shù)方式、術(shù)后病理切緣情況、腺體受累、術(shù)前及術(shù)后6個(gè)月hpv感染,scc、腫瘤家族史、吸煙及飲酒等因素的相關(guān)性。結(jié)果:本研究共納入256例cin患者,其中100例患者于本院門診行l(wèi)eep術(shù),156例患者于本院手術(shù)室行ckc術(shù),術(shù)后共隨訪24個(gè)月,共有20例患者術(shù)后復(fù)發(fā),其中l(wèi)eep組有14例(14%),ckc組有6例(3.85%),leep組術(shù)后復(fù)發(fā)率明顯高于ckc組(or=4.070,95%ci=1.509-10.979),所以ckc的治療效果要明顯高于leep組。將cin患者的臨床病理資料通過(guò)單因素分析得出,cin術(shù)后復(fù)發(fā)殘留與患者的產(chǎn)次(≥2)、絕經(jīng)、術(shù)前病理分級(jí)、cin3病變點(diǎn)數(shù)(≥3點(diǎn))、手術(shù)方式、術(shù)后切緣陽(yáng)性、術(shù)后6個(gè)月hpv持續(xù)陽(yáng)性顯著相關(guān)(x2值分別為7.024;7.449;12.502;5.769;8.723;15.00;40.693),差異具有統(tǒng)計(jì)學(xué)意義(p≤0.05);而與患者的年齡、孕次、宮頸糜爛樣改變程度、術(shù)前hpv感染、scc值、腫瘤家族史、吸煙飲酒史及術(shù)后腺體累及情況并無(wú)相關(guān)性(p0.05)。對(duì)cin術(shù)后復(fù)發(fā)殘留相關(guān)的可能因素進(jìn)行多因素logistic回歸分析可見,絕經(jīng)、cin3病變點(diǎn)數(shù)≥3、術(shù)后切緣陽(yáng)性、術(shù)后6個(gè)月hpv持續(xù)陽(yáng)性是cin患者術(shù)后復(fù)發(fā)的獨(dú)立危險(xiǎn)因素(or值分別為22.853;7.625;16.351;29.691),差異均有統(tǒng)計(jì)學(xué)意義(p≤0.05)。結(jié)論:對(duì)于cin的治療,ckc的治療效果優(yōu)于leep,ckc的術(shù)后復(fù)發(fā)率明顯低于leep。cin患者術(shù)后復(fù)發(fā)殘留與患者的產(chǎn)次(≥2)、絕經(jīng)、術(shù)前病理分級(jí)、cin3病變點(diǎn)數(shù)(≥3點(diǎn))、手術(shù)方式、術(shù)后切緣陽(yáng)性、術(shù)后6個(gè)月HPV持續(xù)陽(yáng)性等因素顯著相關(guān),而與宮頸糜爛樣改變程度、SCC、腫瘤家族史、吸煙、飲酒等情況無(wú)關(guān)。絕經(jīng)、CIN3病變點(diǎn)數(shù)≥3、術(shù)后切緣陽(yáng)性、術(shù)后6個(gè)月HPV持續(xù)陽(yáng)性是CIN患者術(shù)后復(fù)發(fā)的獨(dú)立危險(xiǎn)因素。
[Abstract]:Cervical intraepithelial neoplasia (CIN) is a group of cervical lesions closely related to the occurrence of invasive cervical cancer, which mainly occurs in women aged 25-35. Most of the low-grade CIns can be regressive, but the high-grade CIns have the possibility of carcinogenesis, can develop into invasive cancer, and are considered as precancerous lesions. The pathological grading of cervical intraepithelial neoplasia is divided into three grades: CIN1, CIN2, and CIN3, in which CIN3 includes severe atypical hyperplasia and carcinoma in situ, reflecting the continuous process from cervical lesions to cervical cancer, which takes about 10 years to develop from CIN to cervical cancer. Therefore, early diagnosis and early treatment of CIN can reduce the incidence of cervical cancer. Clinically, the diagnosis of cervical cancer should follow the "three steps" principle: cervical cytology, colposcopy and pathological examination, pathological examination is the golden standard for the diagnosis of cervical cancer. Cryotherapy and so on, but the traditional method trauma is bigger, the patient's postoperative complication rate is higher and easy to recur, currently the clinical application of cervical loop electrosurgical excision (LEEP) and cold knife conization (CKC) to treat cervical intraepithelial neoplasia, has a significant therapeutic effect, but there are still patients with recurrence after surgery. ASCCP's new guidelines for cervical cancer screening recommend that for histologically diagnosed CIN2 and CIN3, surface destruction therapy is not recommended, but diagnostic cervical conization is recommended, but 1-25% of patients fail to treat after surgery. Failure of CIN treatment may lead to recurrence after CIN surgery, but may also develop into invasive cancer. Therefore, analysis of cervical conization The high risk factors of recurrence and residual after resection can be distinguished from the high risk patients of recurrence after CIN treatment. These patients should be followed up closely to find the lesions and further treatment in time to achieve the purpose of early prevention of recurrence of CIN, so as to effectively control the recurrence and progress of the disease. Objective: To evaluate the clinical efficacy of LEEP and CKC in the treatment of CI N, and to compare the intraoperative bleeding volume, postoperative complications and postoperative recurrence rate of the two kinds of surgery. The clinical and pathological data of patients with CIN were analyzed to study the relapse of CIN and its relationship with age, pregnancy, parity, menopause, preoperative pathological grading, CIN 3 lesion number (> 3), cervical erosion-like changes, surgical methods, postoperative pathological margin, gland involvement, preoperative and postoperative 6. Correlation among monthly HPV infection, scc, family history of tumor, smoking and alcohol consumption was studied. High risk factors associated with postoperative recurrence and residue of CIN patients were identified by univariate and multivariate analysis. High risk patients who were prone to recurrence after CIN treatment were identified and followed up closely. If further treatment was found, the patients would be treated promptly. Materials and methods: the clinical and pathological data of 256 patients with CIN admitted to Dalian Medical University from June 2012 to December 2014 were collected and analyzed by SPSS 19.0 statistical software. t test, Pearson x2 test and logistic regression analysis were used to review the data. Sexually analyze the clinical efficacy of LEEP and CKC in the treatment of cin, and analyze the difference of the cure rate and recurrence rate of CIN between the two surgical methods. Univariate and multivariate analysis was used to analyze the postoperative recurrence of cin, residual and age, pregnancy, parity, menopause, preoperative pathological grading, CIN 3 lesion points, cervical erosion-like changes, surgery. Results: A total of 256 patients with CIN were enrolled in this study. 100 of them underwent LEEP in the outpatient department of our hospital, 156 underwent CKC in the operating room of our hospital. A total of 20 patients were followed up for 24 months. Postoperative recurrence was found in 14 cases (14%) in LEEP group, 6 cases (3.85%) in CKC group, and the recurrence rate in LEEP group was significantly higher than that in CKC group (or = 4.070, 95% CI = 1.509-10.979), so the therapeutic effect of CKC was significantly higher than that in LEEP group. Pathological grading, CIN 3 lesion points (> 3 points), surgical methods, positive incision margin, 6 months after surgery, HPV persistent positive significantly correlated (x2 values were 7.024; 7.449; 12.502; 5.769; 8.723; 15.00; 40.693), the difference was statistically significant (p < 0.05); but with the patient's age, pregnancy, cervical erosion-like changes, preoperative HPV infection, SCC value, tumor home There was no correlation between family history, smoking and drinking history and postoperative gland involvement (p0.05). multivariate logistic regression analysis showed that postmenopausal, CIN3 lesion number (> 3), positive incision margin and persistent positive HPV 6 months after operation were independent risk factors for postoperative recurrence of CIN (or value was 22.85, respectively). Conclusion: For the treatment of cin, the curative effect of CKC is better than that of leep, and the recurrence rate of CKC is lower than that of leep. The recurrence rate of CKC is lower than that of leep. cin. The recurrence rate of CKC is lower than that of leep. The persistent positive rate of HPV was significantly correlated with the degree of cervical erosion, SCC, family history of cancer, smoking and alcohol consumption. Positive incision margin, CIN3 lesion number (>3) and persistent positive rate of HPV 6 months after operation were independent risk factors for recurrence of CIN.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33
本文編號(hào)：2244913
[Abstract]:Cervical intraepithelial neoplasia (CIN) is a group of cervical lesions closely related to the occurrence of invasive cervical cancer, which mainly occurs in women aged 25-35. Most of the low-grade CIns can be regressive, but the high-grade CIns have the possibility of carcinogenesis, can develop into invasive cancer, and are considered as precancerous lesions. The pathological grading of cervical intraepithelial neoplasia is divided into three grades: CIN1, CIN2, and CIN3, in which CIN3 includes severe atypical hyperplasia and carcinoma in situ, reflecting the continuous process from cervical lesions to cervical cancer, which takes about 10 years to develop from CIN to cervical cancer. Therefore, early diagnosis and early treatment of CIN can reduce the incidence of cervical cancer. Clinically, the diagnosis of cervical cancer should follow the "three steps" principle: cervical cytology, colposcopy and pathological examination, pathological examination is the golden standard for the diagnosis of cervical cancer. Cryotherapy and so on, but the traditional method trauma is bigger, the patient's postoperative complication rate is higher and easy to recur, currently the clinical application of cervical loop electrosurgical excision (LEEP) and cold knife conization (CKC) to treat cervical intraepithelial neoplasia, has a significant therapeutic effect, but there are still patients with recurrence after surgery. ASCCP's new guidelines for cervical cancer screening recommend that for histologically diagnosed CIN2 and CIN3, surface destruction therapy is not recommended, but diagnostic cervical conization is recommended, but 1-25% of patients fail to treat after surgery. Failure of CIN treatment may lead to recurrence after CIN surgery, but may also develop into invasive cancer. Therefore, analysis of cervical conization The high risk factors of recurrence and residual after resection can be distinguished from the high risk patients of recurrence after CIN treatment. These patients should be followed up closely to find the lesions and further treatment in time to achieve the purpose of early prevention of recurrence of CIN, so as to effectively control the recurrence and progress of the disease. Objective: To evaluate the clinical efficacy of LEEP and CKC in the treatment of CI N, and to compare the intraoperative bleeding volume, postoperative complications and postoperative recurrence rate of the two kinds of surgery. The clinical and pathological data of patients with CIN were analyzed to study the relapse of CIN and its relationship with age, pregnancy, parity, menopause, preoperative pathological grading, CIN 3 lesion number (> 3), cervical erosion-like changes, surgical methods, postoperative pathological margin, gland involvement, preoperative and postoperative 6. Correlation among monthly HPV infection, scc, family history of tumor, smoking and alcohol consumption was studied. High risk factors associated with postoperative recurrence and residue of CIN patients were identified by univariate and multivariate analysis. High risk patients who were prone to recurrence after CIN treatment were identified and followed up closely. If further treatment was found, the patients would be treated promptly. Materials and methods: the clinical and pathological data of 256 patients with CIN admitted to Dalian Medical University from June 2012 to December 2014 were collected and analyzed by SPSS 19.0 statistical software. t test, Pearson x2 test and logistic regression analysis were used to review the data. Sexually analyze the clinical efficacy of LEEP and CKC in the treatment of cin, and analyze the difference of the cure rate and recurrence rate of CIN between the two surgical methods. Univariate and multivariate analysis was used to analyze the postoperative recurrence of cin, residual and age, pregnancy, parity, menopause, preoperative pathological grading, CIN 3 lesion points, cervical erosion-like changes, surgery. Results: A total of 256 patients with CIN were enrolled in this study. 100 of them underwent LEEP in the outpatient department of our hospital, 156 underwent CKC in the operating room of our hospital. A total of 20 patients were followed up for 24 months. Postoperative recurrence was found in 14 cases (14%) in LEEP group, 6 cases (3.85%) in CKC group, and the recurrence rate in LEEP group was significantly higher than that in CKC group (or = 4.070, 95% CI = 1.509-10.979), so the therapeutic effect of CKC was significantly higher than that in LEEP group. Pathological grading, CIN 3 lesion points (> 3 points), surgical methods, positive incision margin, 6 months after surgery, HPV persistent positive significantly correlated (x2 values were 7.024; 7.449; 12.502; 5.769; 8.723; 15.00; 40.693), the difference was statistically significant (p < 0.05); but with the patient's age, pregnancy, cervical erosion-like changes, preoperative HPV infection, SCC value, tumor home There was no correlation between family history, smoking and drinking history and postoperative gland involvement (p0.05). multivariate logistic regression analysis showed that postmenopausal, CIN3 lesion number (> 3), positive incision margin and persistent positive HPV 6 months after operation were independent risk factors for postoperative recurrence of CIN (or value was 22.85, respectively). Conclusion: For the treatment of cin, the curative effect of CKC is better than that of leep, and the recurrence rate of CKC is lower than that of leep. The recurrence rate of CKC is lower than that of leep. cin. The recurrence rate of CKC is lower than that of leep. The persistent positive rate of HPV was significantly correlated with the degree of cervical erosion, SCC, family history of cancer, smoking and alcohol consumption. Positive incision margin, CIN3 lesion number (>3) and persistent positive rate of HPV 6 months after operation were independent risk factors for recurrence of CIN.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33
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