锥切范围对高级别宫颈上皮内瘤变锥切术后复发的影响

发布时间：2018-02-26 13:36

本文关键词： 宫颈上皮内瘤变锥切范围复发预测因素　出处：《第三军医大学学报》2017年20期 　论文类型：期刊论文

【摘要】：目的探索高级别宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)术后复发/持续危险因素,以指导确定锥切范围及制定术后随访计划。方法回顾性分析2013年8月至2016年6月于我院妇科病房行锥切治疗并诊断为高级别宫颈上皮内瘤变的113例,分析其临床病理特征与术后复发的关系。随访时间2~39个月,中位随访时间19个月。结果 113例患者中有9例复发,多因素分析提示标本厚度(锥切宽度)与术后复发密切相关(HR:7.094,95%CI:1.350~37.279,P=0.021)。手术中锥切宽度小于1.77 cm时,其预测术后复发灵敏度为88.9%,特异度为83.8%,曲线下面积(AUC)为0.81(95%CI:0.650~0.971);锥切深度小于2.24 cm时,预测复发灵敏度为44.4%,特异度为87.9%,曲线下面积(AUC)为0.689(95%CI:0.492~0.886)。此外,高危HPV感染(HR:8.674,95%CI:1.047~71.862)、阴道分娩≥2次(HR:10.708,95%CI:1.543~74.322)亦为复发危险因素(P0.05)。结论锥切范围不够是高级别宫颈上皮内瘤变的复发高危因素,建议尽可能行深宽锥切,对合并高危HPV感染、多次阴道分娩、锥切宽度小于1.77 cm、锥切深度小于2.24 cm者,术后需联合宫颈细胞学、HPV基因分型和阴道镜密切随访。
[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.
【作者单位】：重庆医科大学附属第一医院妇产科;
【分类号】：R737.33

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