摘要
目的分析高级别宫颈上皮内瘤变(CIN)在宫颈锥切(CKC)术后的转归,探讨病变复发的相关危险因素,提高诊疗水平并改善预后。方法回顾性分析2017-07-01-2018-12-31厦门大学附属第一医院诊断为高级别CIN并接受CKC治疗患者136例,分析其临床资料,对术后病理、再手术情况、术后随访过程中病灶残留或复发情况进行归纳。采用SPSS 22.0对数据进行统计学分析,对CKC术后复发的危险因素行单因素及多因素Logistic回归模型分析。结果136例高级别CIN患者中,CKC术后有6.62%(9/136)的患者提示早浸及以上癌变,病理升级;70.59%(96/136)的患者提示高级别CIN,病理同术前;22.79%(31/136)的患者提示炎症或低级别CIN。CKC术后随访2年发现复发率为12.37%(12/97),复发与CKC深度、切缘、高危型人乳头瘤病毒(HR-HPV)持续感染、病灶广泛累腺存在相关性,差异有统计学意义,P<0.05;手术切缘残留(HR=7.233,95%CI:0.897~10.113)与HR-HPV持续感染(HR=2.445,95%CI:0.517~3.204)是其独立风险因素。结论高级别CIN患者选择CKC手术,针对术后存在的复发危险因素采取针对性的预防措施,降低术后复发率。
Objective To analyze the outcome of high-grade cervical intraepithelial neoplasia(CIN)after cervical conization(CKC),explore the risk factors of disease recurrence,and improve the level of diagnosis,treatment and prognosis.Methods Totally 136 patients diagnosed as high-grade CIN and treated with CKC in the First Affiliated Hospital of Xiamen University from July 1,2017 to December 31,2018 were analyzed retrospectively.Their clinical data,including the postoperative pathological return,reoperation and residual or recurrence of lesions were analyzed.The risk factors of recurrence after CKC were statistically analyzed by univariate and multivariate Logistic regression model by SPSS 22.0.Results 9 cases(9/136,6.62%)showed early invasion and pathological upgrading;96 cases(96/136,70.59%)showed high-grade CIN,and the pathology was the same as that before operation;31 cases(31/136,22.79%)showed inflammation or low-grade CIN.The recurrence rate of CKC was 12.37%(12/97).It was found that the recurrence was related to the depth of CKC,the cutting edge,the continuous infection of high-risk human papillomavirus(HR-HPV)and the extensive involvement of glands.Surgical margin residue(HR=7.233,95%CI:0.897-10.113)and HR-HPV persistent infection(HR=2.445,95%CI:0.517-3.204)were independent risk factors.Conclusions CKC is selected for patients with high-grade CIN.Targeted preventive measures should be taken according to the risk factors of postoperative recurrence to reduce the postoperative recurrence rate.
作者
黄睿
汪延斌
HUANG Rui;WANG Yan-bin(The First Affiliated Hospital of Xiamen University,Xiamen,361003,China)
出处
《社区医学杂志》
CAS
2022年第3期141-145,共5页
Journal Of Community Medicine
关键词
宫颈上皮内瘤变
锥切
复发
危险因素
cervical intraepithelial neoplasia
cervical conization
recurrence
risk factors
