高级别宫颈上皮内瘤变宫颈锥切术后病灶残留的相关因素分析

目的了解高级别宫颈上皮内瘤变（CIN）宫颈锥切术后病灶残留状况及相关影响因素，探讨宫颈锥切术后需要补充手术的必要性。方法通过回顾性分析因高级别宫颈上皮内瘤变（CIN Ⅱ~Ⅲ）行宫颈锥切术，术后1个月即入院再次行全子宫切除手术的200例病人，通过单因素及logistic回归模型分析探讨年龄、孕产史、HR-HPV基因型、CIN分级、锥切方式、切缘状态与病灶残留之间的相关性。结果200例病人中，98例（49.0%）子宫切除标本中有残留病变，年龄、产次、锥切方式与术后病灶残留之间无相关性；CIN分级、术前HPV-16或HPV-18阳性、切缘状态与病灶残留呈正相关，logistic回归分析发现CIN分级、切缘阳性和16/18型HPV检测结果均为病变残留的高危因素。结论CIN分级、切缘阳性和术前HPV-16或HPV-18基因型阳性是高级别CIN行锥切术后病灶残留的可靠预测因子。

Analysis of the related factors of residual lesions after cervical conization for high-grade cervical intraepithelial neoplasia

ObjectiveTo investigate the residual status and related factors of lesions after conization of high-grade cervical intraepithelial neoplasia(CIN), and explore the necessity of supplementary surgery after conization.MethodsThe clinical data of 200 high-grade CIN(CIN Ⅱ-Ⅲ) patients treated with conization and total hysterectomy one month after surgery were retrospectively analyzed. The correlation between the age, pregnancy history, HR-HPV genotype, CIN grade, conic resection method, resection margin status and residual lesions were analyzed using univariate and logistic regression model.ResultsOf the 200 patients, the residual lesions in the hysterectomy specimens in 98 cases(49.0%) were found, and there was not correlation between the age, birth rate, coning method and postoperative residual lesions. The CIN grade, positive preoperative HPV-16 or HPV-18 and margin status were positively correlated with the residual lesions. The results of logistic regression analysis showed that the CIN grade, positive margin and HPV-16 or HPV-18 test results were the high risk factors of residual lesions.ConclusionsThe CIN grade, positive margin and preoperative HPV-16 or HPV-18 genotype are the reliable predictors of residual lesions after conization for high-grade CIN.