論著(zhù)
宮頸HSIL行錐切術(shù)后病灶殘留高危因素及子宮切除時(shí)機探討
王三鋒 胡克 鐘沅月 麥碧 何裕 張煦 黎玉涵
【摘要】 【摘要】目的 探討宮頸高級別鱗狀上皮內病變行宮頸錐切錐切術(shù)后病變殘留的危險因素及子宮切除術(shù)的時(shí)機。方法 收集2015年1月至2017年12月在廣東省婦幼保健院因宮頸高級別鱗狀上皮內病變行宮頸錐切后再行子宮切除患者的臨床資料；統計子宮切除前后病理結果、術(shù)后半年及術(shù)后1年HPV轉陰情況；分析年齡、HPV類(lèi)型、宮頸轉化區類(lèi)型、切緣狀態(tài)、宮頸補切狀態(tài)對病變殘留的影響。
【關(guān)鍵字】 宮頸鱗狀上皮內病變,子宮切除術(shù),宮頸錐切術(shù),病變殘留,危險因素
中圖分類(lèi)號：文獻標識碼：文章編號：
[Abstract] Objective To analyze the risk factors of residual lesions after conization of cervical high-grade squamous intraepithelial lesions and to explore the time of hysterectomy. Methods The clinical data of patients undergoing hysterectomy after conization of cervix due to cervical high-grade squamous intraepithelial lesions in Guangdong Women and Children Hospital from January 2015 to December 2017 was collected. The pathological manifestations before and after hysterectomy were compared and the regression condition of HPV 6 months and 1 year after hysterectomy was recorded. The effects of age, HPV type ,cervical transformation zone type, incision margin state and endocervical incision state on the residual disease were analyzed. Result Among the 107 cases performed with hysterectomy （64 cases with positive resection margin, 43 cases with negative resection margin）, the incidence rate of residual lesions in positive resection margin group（27.91%） and negative resection margin group（50.00%） had significant difference （P=0.0378）. Postoperative pathological upgrading occurred in 3 cases, all of which were found to be stage IA1 cervical cancer. The multivariate analysis showed that positive margin of cervical incision was a high risk factor for residual disease [OR=2.469 （95% CI 1.05-5.83）]. There was no significant difference on residual disease in groups of age, HPV type, type of transformation zone and endocervical incision state. Conclusion Positive resection margin is a high risk factor for the occurrence of residual lesions after HSIL conization. Pathological examination of the cervical conization samples should be performed before hysterectomy.
宮頸癌是婦科常見(jiàn)惡性腫瘤之一，隨著(zhù)宮頸癌篩查普及，臨床中癌前病變的發(fā)現大幅增加。宮頸癌前病變傳統病理命名是宮頸上皮內瘤變三級（CINⅠ、Ⅱ、Ⅲ），2012年ASSCP提出用兩級分類(lèi)法代替三級分類(lèi)法來(lái)命名宮頸癌前病變，即低級別鱗狀上皮內病變（low-grade squamous intraepithelial lesion，LSIL）和高級別鱗狀上皮內病變（high-grade squamous intraepithelial lesion，HSIL）[1]，兩級分類(lèi)法彌補了以前三級分類(lèi)法的不足[2]。宮頸LSIL約90%可自然消退，無(wú)需治療，隨診即可；宮頸HSIL進(jìn)展為宮頸癌的風(fēng)險有20%左右，應積極治療。宮頸錐切是宮頸HSIL有效治療手段，錐切術(shù)后病變有殘留風(fēng)險，影響因素有爭議；子宮切除術(shù)是宮頸HSIL的選擇之一，手術(shù)選擇時(shí)機也有一定爭議[3-4]。本研究選擇廣東省婦幼保健院2015年1月至2017年12月因宮頸HSIL行切除子宮者作為研究對象，探討宮頸HSIL宮頸錐切術(shù)后病變殘留的危險因素及子宮切除術(shù)的手術(shù)時(shí)機。
