CAJ | 학술논문

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.
목적 탐토여자궁경추형절제술(추절)후궁경병조잔류유관적인소.방법 이용105례추절술후3개월내접수후속수술적궁경상피내류변(CIN)화궁경미소침윤암(MIC)환자적림상병리자료,대추절후궁경병조잔류적상관인소진행분석.환자년령(43±6)세,기중CIN3 77례,Ia1기궁경암20례,Ia2기궁경암8례.추절후속수술포괄95례전자궁(혹가쌍부건)절제,2례중복추절,8례엄범자궁절제가분강림파결절제.결과 105례환자중,53례(50.5%)환자적추절후속수술궁경표본중잔류병조,기중38례잔류병조위CIN2혹이하병변.단인소분석현시,환자적월경/생육상황、궁경세포학결과 、추절수술방법 화범위등여추절후시부잔류병조무상관성.환자년령≤45세、추절표본절연양성시추절후궁경잔류병조적위험인소[사연비(OR)분별위4.68화5.40,균P<0.05].MIC환자여CIN3、CIN2혹이하병변적환자상비,기추절후궁경잔류병조비례적차이무통계학의의(P>0.05).다인소Logistic회귀분석현시,절연양성시추절후궁경잔류병조적독립위험인소(OR=4.20,P<0.05).결론 진관궁경병변적엄중정도시결정추절후재처리적주요의거,단타불능예측추절후시부유병조잔류.제추절표본적절연상태외,기타림상병리인소재예측추절후병조잔류중적개치유한.
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.