本文關(guān)鍵詞： 宮頸上皮內(nèi)瘤變 錐切范圍 復(fù)發(fā) 預(yù)測(cè)因素　出處：《第三軍醫(yī)大學(xué)學(xué)報(bào)》2017年20期 　論文類型：期刊論文

【摘要】：目的探索高級(jí)別宮頸上皮內(nèi)瘤變(cervical intraepithelial neoplasia,CIN)術(shù)后復(fù)發(fā)/持續(xù)危險(xiǎn)因素,以指導(dǎo)確定錐切范圍及制定術(shù)后隨訪計(jì)劃。方法回顧性分析2013年8月至2016年6月于我院婦科病房行錐切治療并診斷為高級(jí)別宮頸上皮內(nèi)瘤變的113例,分析其臨床病理特征與術(shù)后復(fù)發(fā)的關(guān)系。隨訪時(shí)間2~39個(gè)月,中位隨訪時(shí)間19個(gè)月。結(jié)果 113例患者中有9例復(fù)發(fā),多因素分析提示標(biāo)本厚度(錐切寬度)與術(shù)后復(fù)發(fā)密切相關(guān)(HR:7.094,95%CI:1.350~37.279,P=0.021)。手術(shù)中錐切寬度小于1.77 cm時(shí),其預(yù)測(cè)術(shù)后復(fù)發(fā)靈敏度為88.9%,特異度為83.8%,曲線下面積(AUC)為0.81(95%CI:0.650~0.971);錐切深度小于2.24 cm時(shí),預(yù)測(cè)復(fù)發(fā)靈敏度為44.4%,特異度為87.9%,曲線下面積(AUC)為0.689(95%CI:0.492~0.886)。此外,高危HPV感染(HR:8.674,95%CI:1.047~71.862)、陰道分娩≥2次(HR:10.708,95%CI:1.543~74.322)亦為復(fù)發(fā)危險(xiǎn)因素(P0.05)。結(jié)論錐切范圍不夠是高級(jí)別宮頸上皮內(nèi)瘤變的復(fù)發(fā)高危因素,建議盡可能行深寬錐切,對(duì)合并高危HPV感染、多次陰道分娩、錐切寬度小于1.77 cm、錐切深度小于2.24 cm者,術(shù)后需聯(lián)合宮頸細(xì)胞學(xué)、HPV基因分型和陰道鏡密切隨訪。
[Abstract]:Objective to explore the risk factors of recurrence / persistence of cervical intraepithelial neoplasia (intraepithelial neoplasia cin) in patients with high grade cervical intraepithelial neoplasia. Methods from August 2013 to June 2016, 113 cases of high grade cervical intraepithelial neoplasia were treated with conization in gynecological ward of our hospital and diagnosed as high grade cervical intraepithelial neoplasia. The relationship between clinicopathologic features and postoperative recurrence was analyzed. The follow-up time was 2 ~ 39 months and the median follow-up time was 19 months. Multivariate analysis showed that the thickness of specimen (width of conization) was closely related to the recurrence after operation. When the width of cone incision was less than 1.77 cm, the sensitivity of predicting recurrence was 88.9, the specificity was 83.8, the area under the curve was 0.81-95CI0.6500.971cm, the depth of cone was less than 2.24 cm, and the depth of cone cutting was less than 2.24 cm. The predictive sensitivity of recurrence is 44.4, the specificity is 87.9, the area under the curve is 0.689C9CI0.492CI0.8860.Furthermore, HR8.67495CI1.04771.862, HR10.70895CIK1.54374.322) is also a risk factor for recurrence of cervical intraepithelial neoplasia with high grade cervical epithelium. Conclusion the range of conical resection is not enough, and it is also a risk factor for high grade cervical intraepithelial neoplasia. It was suggested to perform deep and wide conization as far as possible, for multiple vaginal delivery with high risk of HPV infection. If the width of conization was less than 1.77 cm and the depth of conization was less than 2.24 cm, it was necessary to combine cervical cytology with HPV genotyping and colposcopy follow-up.
【作者單位】： 重慶醫(yī)科大學(xué)附屬第一醫(yī)院婦產(chǎn)科;
【分類號(hào)】：R737.33

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