宫颈高级别病变患者宫颈锥切术后病理升级的相关预测因素分析

发布时间：2018-02-20 16:41

  本文关键词： 宫颈高级别病变 子宫颈癌 病理升级 预测因素 风险评估　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景及研究目的:宫颈浸润癌在发病前要经历较长的癌前病变阶段。研究表明CIN2-3患者有15%-30%病变将进一步发展为子宫颈癌。近年来,随着对子宫颈疾病的重视和筛查的普及,越来越多的患子宫颈疾病包括宫颈高级别病变及子宫颈浸润癌的患者被早期发现。目前手术仍然是对宫颈高级别病变治疗的主要方法,其中手术方式根据病变不同又有宫颈锥切术或子宫全切术。对宫颈高级别病变的患者切除子宫时,存在有如下问题,若直接行子宫切除术,约7%的患者术后病理结果最终被诊断为子宫颈癌,这就会出现手术范围的不足,所以对于宫颈高级别病变患者行子宫切除术前,往往需要诊断性锥切。若诊断锥切常规病理结果回示病变升级,就需要扩大手术,行子宫切除术,该过程中,患者及家属焦虑,且感染机率增加,患肢经历多次手术麻醉,住院时间延长,这给患者和家属带来了较大的经济负担和精神压力,有学者主张采用术中诊断性锥切,行快速病理检查,并根据冰冻结果立即行子宫切除术或扩大手术范围,这虽可避免上述弊端,但面临冰冻结果不准确,手术范围不恰当可能,仍面临不恰当手术风险。所以医生需要在宫颈高级别病变患者住院时通过患者本身临床特征及辅助检查来判断患者病理是否会升级,为宫颈高级别病变患者选择合理的手术方式。本研究主要目的是,对预测宫颈高级别病变患者术后病理是否升级的相关因素进行分析,对术后病理是否升级进行评估,为合理选择手术方式做参考。方法:收集2011年1月至2015年12郑州大学第一附属医院因宫颈高级别病变行宫颈锥切术患者临床资料共2200例,对病例进行整理后,发现阴道炎史、高危HPV感染史、宫颈转化区、口服避孕药、接触性出血、结婚年龄、初产年龄、孕产次、MRI检查结果、病变累犯点位数、年龄、吸烟史、非HPV感染的性传播疾病(Sexually transmitted diseases,STD)13个因素完善患者病历共1032例。统计这1032例患者宫颈锥切术后病理结果,根据结果的不同分为病理升级组和病理未升级组。并对各预测因素进行单因素方差分析,取P0.05为差异有统计学意义,将有差异统计学意义的各因素进行多因素二元logistic回归分析,所有数据均采用SPSS 21.0软件分析。结果:对这13个因素进行分析,阴道炎史卡方值为0.954,p值为0.329;高危HPV感染卡方值为0.001,p值为0.985;口服避孕药卡方值为7.176,p值为0.070;宫颈转化区类型卡方值为86.219,p值为0.001;接触性出血卡方值为0.073,p值为0.786;结婚年龄卡方值为0.580,p值为0.809;初产年龄卡方值为0.815,p值为0.367;孕产次卡方值为0.380,p值为0.538;MRI检查结果卡方值为713.658,p值为0.001;病变累犯的点位数卡方值为28.984,p值为0.001;年龄卡方值为94.630,p值为0.001;吸烟史卡方值为6.713,p值为0.070;STD非HPV卡方值为9.299,p值为0.002。结果显示宫颈转化区类型、MRI检查结果、病变累犯点位数≥3个、绝经妇女、吸烟、非HPV感染的性传播疾病(STD)这6个因素对结果影响存在差异(P0.05),将这6个因素进行多因素二元logistic回归分析后发现这六个因素均为预测术后病理结果升级的独立危险因素。结论:宫颈转化区类型、MRI检查结果、病变累犯点位数≥3个、绝经妇女、吸烟、非HPV感染的性传播疾病(STD)为预测宫颈高级别病变患者病理是否升级的独立危险因素,术前完善相关检查,并对这些资料进行收集,能提高对术后病理是否升级的预测的准确性,对于临床医生制定手术方案具有一定的参考意义。
[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. 鍥犵礌杩涜�屽崟鍥犵礌鏂瑰樊鍒嗘灒�

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