宫颈锥切术后病变残留的危险因素分析

目的:探讨宫颈高级别鳞状上皮内病变(high grade squamous intraepithelial lesions,HSIL)行宫颈锥切术后切缘阳性患者,出现病变残留的预测因素。方法:对我院2018年6月至2018年12月因HSIL锥切手术,因切缘阳性接受二次手术的80例患者进行横断面研究,采用单因素及多因素Logistic回归模型,分析患者年龄、生育情况、绝经状态、吸烟与否、高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)感染型别、宫颈液基细胞学检查结果、颈管搔刮结果、转化区类型、病变是否累及腺体、病变范围(累及象限)、圆锥周长、圆锥长度、阳性切缘位置等因素与宫颈锥切术后病变残留的相关性。结果:单因素分析显示宫颈HSIL患者锥切术后病变残留与绝经状态(P=0.025)、HR-HPV感染型别(P=0.011)、转化区类型(P=0.005)、圆锥长度(P<0.001)相关;多因素回归分析提示圆锥长度(OR=0.21,CI 0.071~0.633)和转化区类型(OR=2.394 CI 3.198~4.100)是病变残留的独立危险因素。结论:转化区类型和锥长是锥切术后病变残留的独立危险因素。

Risk Factors for the Incidence of Residual Lesions after Cervical Conization

Objective:To explore factors predicting the incidence of residual lesions in high grade squamous intraepitheli-al lesions(HSIL)patients with positive margin after cervical conization.Methods:A cross-sectional study was conducted on 80 HSIL patients who got positive margin after conization and underwent the second surgery in our hospital from June 2018 to December 2018.Logistic regression models were used to analyze the correlation between the incidence of residual lesions and factors including age,parity,postmenopausal status,history of smoking,types of high-risk human papillomavirus(HR-HPV),results of liquid based cytology,results of endocervical curettage(ECC),types of transformation zone,the extent of lesions(involved quadrants),glandular involvement,the location of the positive margin,the perimeter of cone and the length of cone.Results:Monofactor analysis showed that the incidence of residual lesions were correlated with postmenopa-usal status(P=0.025),the type of HR-HPV(P=0.011),the type of transformation zone(P=0.005)and the length of cone(P=0.000).Multivariate regression analysis suggested that the length of cone(OR=0.21,CI=0.071-0.633)and the type of transformation zone(OR=2.394,CI=3.198-4.100)were independent risk factors for the incidence of residual lesions.Conclusion:The type of transformation zone and cone length are independent risk factors for the incidence of residual lesions after conization.