子宫颈上皮内瘤变和微小浸润癌患者子宫颈锥形切除术后病灶残留的预测因素

目的 探讨与子宫颈锥形切除术(锥切)后宫颈病灶残留有关的因素.方法 利用105例锥切术后3个月内接受后续手术的宫颈上皮内瘤变(CIN)和宫颈微小浸润癌(MIC)患者的临床病理资料,对锥切后宫颈病灶残留的相关因素进行分析.患者年龄(43±6)岁,其中CIN3 77例,Ia1期宫颈癌20例,Ia2期宫颈癌8例.锥切后续手术包括95例全子宫(或加双附件)切除,2例重复锥切,8例广泛子宫切除加盆腔淋巴结切除.结果 105例患者中,53例(50.5%)患者的锥切后续手术宫颈标本中残留病灶,其中38例残留病灶为CIN2或以下病变.单因素分析显示,患者的月经/生育状况、宫颈细胞学结果 、锥切手术方法 和范围等与锥切后是否残留病灶无相关性.患者年龄≤45岁、锥切标本切缘阳性是锥切后宫颈残留病灶的危险因素[似然比(OR)分别为4.68和5.40,均P<0.05].MIC患者与CIN3、CIN2或以下病变的患者相比,其锥切后宫颈残留病灶比例的差异无统计学意义(P>0.05).多因素Logistic回归分析显示,切缘阳性是锥切后宫颈残留病灶的独立危险因素(OR=4.20,P<0.05).结论 尽管宫颈病变的严重程度是决定锥切后再处理的主要依据,但它不能预测锥切后是否有病灶残留.除锥切标本的切缘状态外,其他临床病理因素在预测锥切后病灶残留中的价值有限.

Predictors of residual lesion in cervix after conization in patients with cervical intraepithelial neoplasia and microinvasive cervical cancer

Objective To determine the clinicopathological factors predicting residual lesions after conization in patients with cervical intraepithelial neoplasia (CIN) and microinvasive carcinoma of cervix (MIC). Methods The clinical data of 77 patients with CIN3, 20 patients with stage lal cervical cancer, and 8 patients with stage Is2 cervical cancer, totally 105 patients, aged (43 + 6), who received further surgery within 3 months after eonization, 95 receiving hysterectomy, 2 receiving repeated conization, and 8 receiving radical hysterectomy and pelvic lymph node dissection, were evaluated. The demographic features, clinical and pathological parameters, and the correlation thereof with the post-eonization residual lesions were analyzed retrospectively. Results Residual lesions were found in the specimens obtained from hysterectomy or repeated conizafion of 53 of the 105 patients (50.5%), among which 38 were CIN2 or less severe lesions. Univariate analysis showed that menopausal status, procreation status, cervical cytology, method of eonization, and range of resection were not correlated with the presence of post-conization residual lesion, while age ≤45 (P<0.05, odd ratio [OR] =4.68) and positive resection margin (P<0.05, OR=5.40) were risk factors of residual lesion. There were no differences in the proportion of post-conization residual lesion among the patients with MIC, CIN 3, CIN2 or less severe lesions. Multivariate logistic analysis showed that only the positive resection margin was an independent risk factor of residual lesion after conization (P <0.05, OR = 4.20). Conclusions Although severity of the cervical disease is the most important factor in determining post-conization treatment, it is not a predicting factor for post-conization residual lesion. Only the positive resection margin was an independent risk factor of residual lesion after conization.