宫颈高级别鳞状上皮内病变锥切切缘阴性患者复发相关因素分析

发布时间：2018-05-30 17:59

本文选题：宫颈癌 + 高级别鳞状上皮内病变　；参考：《浙江大学》2016年博士论文

【摘要】：目的：本研究旨在探讨宫颈高级别鳞状上皮内病变锥切切缘阴性患者病变复发的相关因素。方法：回顾性分析2010年6月1日至2015年5月31日在我院因HSIL锥切切缘阴性病变复发入院治疗患者66例。采用1：2匹配病例对照研究,分析年龄、绝经情况、妊娠分娩次数、合并主诉与否、高危HPV感染、宫颈细胞学结果、病变累及腺体、病变累及多象限、颈管诊刮阳性、病变范围这些因素是否为宫颈锥切切缘阴性患者术后复发的相关因素。结果：复发组患者年龄在23-69岁之间,中位数46岁。首次手术治疗后复发间隔时间为4-72个月,中位数12个月,术后复发有31.8%发生在2年后。复发组年龄40岁及以上占72.7%；对照组年龄40岁及以上占54.5%。单因素分析显示,年龄大于40岁与宫颈HSIL锥切术后病变复发相关(OR=2.286,P=0.0140.05)。复发组术前细胞学ASC-H或HSIL占66.7%；对照组占46.9%。单因素分析显示,细胞学ASC-H或HSIL与宫颈HSIL锥切术后病变复发相关(OR= 2.652, P= 0.007 0.05)。多因素分析显示,年龄大于40岁和术前细胞学ASC-H或HSIL均是宫颈HSIL切锥切缘阴性患者术后复发的独立相关因素。结论：宫颈HSIL锥切切缘阴性患者病变复发率达1.4%,其中31.8%在术后2年以后复发,这提示HSIL锥切切缘阴性患者术后长期随访不容忽视。年龄大于40岁和术前细胞学ASC-H或HSIL是宫颈HSIL锥切切缘阴性患者病变复发的独立风险因素,对合并该两因素之一的患者加强术后随访是必要的。
[Abstract]:Objective: to investigate the risk factors of recurrence of cervical high grade squamous intraepithelial lesions with negative conical incisal margin. Methods: from June 1, 2010 to May 31, 2015, 66 patients with recurrent HSIL conical margin negative lesions in our hospital were retrospectively analyzed. A 1:2 matched case-control study was used to analyze age, menopause, times of pregnancy and delivery, main complaint or not, high risk HPV infection, cervical cytological results, involvement of glands, involvement of multiple quadrants, positive cervical canal curettage. Whether these factors are related to recurrence after operation in patients with negative cutting edge of cervical cones. Results: the patients in recurrent group were aged 23-69 years with a median age of 46 years. The interval of recurrence was 4-72 months (median 12 months). 31.8% of the recurrence occurred 2 years later. The recurrence group was 72.7 years old and the control group was 54.5 years old. Univariate analysis showed that the age of more than 40 years was associated with the recurrence of cervical lesions after HSIL conization. ASC-H or HSIL was 66.7% in the recurrent group and 46.9% in the control group. Univariate analysis showed that cytological ASC-H or HSIL was associated with recurrence of cervical HSIL conization with OR = 2.652, P = 0.007. Multivariate analysis showed that age over 40 years old and preoperative cytologic ASC-H or HSIL were independent correlation factors for postoperative recurrence in patients with negative edge of HSIL. Conclusion: the recurrence rate of cervical HSIL conical incision with negative margin is 1.4, 31.8% of which recur 2 years after operation, which suggests that the long term follow-up of patients with negative conical incision edge of HSIL can not be ignored. ASC-H or HSIL were independent risk factors for recurrence in patients with negative margin of HSIL conical incisal. It is necessary to strengthen postoperative follow-up for patients with one of these two factors.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R737.33

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