冷刀锥切术切缘阴性的重度宫颈鳞状上皮内瘤变患者的预后影响因素分析

目的探讨冷刀锥切术切缘阴性的重度宫颈鳞状上皮内瘤变（HSIL）患者的预后影响因素。方法回顾分析1999年1月至2004年1月间,卫生部北京医院妇产科266例冷刀锥切手术切缘阴性的HSIL患者的临床资料,分析影响预后的因素,并随访治疗结局。其中宫颈上皮内瘤变（CIN）II20例,CIN11246例（包括原位癌82例）;腺体累及者40例,无腺体累及者226例;257例检测高危型人乳头状瘤病毒（HPV）患者中,高危型HPV阳性244例,阴性13例。结果中位数随访时间46个月,总复发率为8．6％（23／266）,无浸润癌发生。CINⅡ患者中1例（5．0％,1／20）复发,CINⅢ患者（不包括原位癌）中9例（5．5％,9／164）复发,而82例原位癌中13例（15．8％,13／82）复发,原位癌与CINⅡ及CINⅢ（不包括原位癌）患者复发率比较,差异均有统计学意义（P〈0．05）。腺体累及者中7例（17．5％,7／40）复发,无腺体累及者中16例（6．0％,16／226）复发,两者比较,差异有统计学意义（P〈0．05）。高危型HPV阳性者中21例（8．6％,21／244）复发,而13例高危型HPV阴性者中无一例复发,两者比较,差异有统计学意义（P〈0．05）。结论冷刀锥切术切缘阴性的HSIL复发率低;病理分级高和腺体受累是影响疗效及预后的因素。

Prognostic factors of cervical high-grade squamous intraepithelial lesions treated by cold knife conization with negative margin

OBJECTIVE: To investigate the prognostic factors of cervical high-grade squamous intraepithelial lesions treated by cold knife conization with negative margin. METHODS: Two hundred and sixty-six women with cervical high-grade squamous intraepithelial lesions treated by cold-knife conization with negative margins at Beijing Hospital between Jan 1999 and Jan 2004 were analyzed retrospectively. All patients were followed up with cytology, high-risk human papillomavirus (HPV) test and colposcopy if necessary. RESULTS: The cervical CIN recurrence rate was 8.6% with no incidence of invasive cervical cancer after a median follow-up of 46 months. The recurrence was related to the grade of lesions and gland involvement pathologically. One of 20 (5.0%) cases with cervical intraepithelial neoplasia (CIN) II, 9 of 164 (5.5%) cases with CIN III (excluding carcinoma in situ, CIS) and 13 of 82 (15.8%) cases with CIS recurred (P < 0.05). Seven of 40 (17.5%) cases with gland involvement and 16 of 226 (6.0%) cases without gland involvement recurred (P < 0.05). High-risk HPV tests were performed in 257 of 266 cases before surgery. Twenty one of 244 cases (8.6%) with positive high-risk HPV recurred and none of 13 cases with negative test recurred. CONCLUSIONS: There are few recurrences for cervical high-grade squamous intraepithelial lesions treated by cold knife conization with negative margins. Close follow-up is needed for those high grade lesions and those with gland involvement.