CAJ | 학술논문

目的分析宫颈锥切术后切缘阳性的相关因素.方法回顾性分析2000年1月至2008年2月经阴道镜宫颈活检诊断为宫颈上皮内瘤变(CIN)并接受宫颈锥切术的患者1699例,对患者年龄、病变程度、病变范围、手术方式及是否绝经与宫颈锥切术切缘阳性率作单因素和多因素分析.结果 1699例宫颈锥切术患者中,切缘阳性者238例,阳性率为14.01%.切缘阳性者平均年龄(39±9)岁,切缘阴性者平均年龄(39±8)岁,两者比较,差异无统计学意义(P>0.05).行冷刀锥切术者788例,切缘阳性率8.63%(68/788);行环形电极切除术(LEEP)者911例,切缘阳性率18.66%(170/911),两者比较,差异有统计学意义(P<0.01).CIN Ⅰ者90例,CIN Ⅱ者339例,CIN Ⅲ者1113例[其中重度不典型增生972例,原位癌(CIS)141例],宫颈癌Ⅰ al期87例,Ⅰ a2期及以上70例,切缘阳性率分别为1.11%(1/90)、3.83%(13/339)、10.70%(104/972)、26.24%(37/141)、35.63%(31/87)和74.29%(52/70),CIN Ⅰ与CINⅡ者比较,差异无统计学意义(P>0.05);将CIN Ⅰ与CINⅡ者合并计算,并与CIN Ⅲ、宫颈癌Ⅰ a1期、Ⅰ a2期及以上者之间比较,差异均有统计学意义(P<0.05).未绝经者1569例,切缘阳性率为13.38%(210/1569);已绝经者130例,切缘阳性率为21.54%(28/130);两者比较,差异有统计学意义(P=0.010).多因素logistic回归分析发现,手术方式、病变程度、病变范围、宫颈外观、是否绝经是与切缘阳性高度相关的因素,相对危险度分别为5.147、3.048、1.271、1.905和1.860.结论宫颈病变程度严重、病变范围大、LEEP、绝经后是宫颈锥切术切缘阳性的高危因素,在制定宫颈锥切手术方式时应予以重视.
목적 분석궁경추절술후절연양성적상관인소.방법 회고성분석2000년1월지2008년2월경음도경궁경활검진단위궁경상피내류변(CIN)병접수궁경추절술적환자1699례,대환자년령、병변정도、병변범위、수술방식급시부절경여궁경추절술절연양성솔작단인소화다인소분석.결과 1699례궁경추절술환자중,절연양성자238례,양성솔위14.01%.절연양성자평균년령(39±9)세,절연음성자평균년령(39±8)세,량자비교,차이무통계학의의(P>0.05).행냉도추절술자788례,절연양성솔8.63%(68/788);행배형전겁절제술(LEEP)자911례,절연양성솔18.66%(170/911),량자비교,차이유통계학의의(P<0.01).CIN Ⅰ자90례,CIN Ⅱ자339례,CIN Ⅲ자1113례[기중중도불전형증생972례,원위암(CIS)141례],궁경암Ⅰ al기87례,Ⅰ a2기급이상70례,절연양성솔분별위1.11%(1/90)、3.83%(13/339)、10.70%(104/972)、26.24%(37/141)、35.63%(31/87)화74.29%(52/70),CIN Ⅰ여CINⅡ자비교,차이무통계학의의(P>0.05);장CIN Ⅰ여CINⅡ자합병계산,병여CIN Ⅲ、궁경암Ⅰ a1기、Ⅰ a2기급이상자지간비교,차이균유통계학의의(P<0.05).미절경자1569례,절연양성솔위13.38%(210/1569);이절경자130례,절연양성솔위21.54%(28/130);량자비교,차이유통계학의의(P=0.010).다인소logistic회귀분석발현,수술방식、병변정도、병변범위、궁경외관、시부절경시여절연양성고도상관적인소,상대위험도분별위5.147、3.048、1.271、1.905화1.860.결론궁경병변정도엄중、병변범위대、LEEP、절경후시궁경추절술절연양성적고위인소,재제정궁경추절수술방식시응여이중시.
Objective To assess the high risk factors associated with the positive margin of conization in patients with cervical intraepithelial neoplasia (CIN). Methods From January 2000 to February 2008, 1699 consecutive patients with CIN undergoing conization was reviewed retrospectively in order to analyze the relationship between the positive margin of conization with clinical prognostic factors,such as patients age, disease grade, size of lesion, the procedure of excision and menopause. X<'2> tests was used to compare the different frequencies of factors in groups of positive and negative margin conization, then seven factors with positive margin were processed into unconditional logistic regression analysis. Results The rate of the positive margin in 1699 patients was 14.01% (238/1699). The mean age of patients with positive margins was (39±9 ) years old, while patients with negative margins was ( 39±8 ) years old, which didn't reach statistical difference(P>0.05). The rate of the positive margin was 8.63% in cold knife cone (CKC) and 18.66% in loop electrosurgical excision procedure (LEEP), which showed significant difference( P<0.01 ). Among 1699 patients, 90 patients were with CIN Ⅰ ,339 patients were with CIN Ⅱ ,1113 patients were with CIN Ⅲ [ including 972 with severe dysplasia and 141 with cancer in situ(CIS) ],87 patients were with cervical cancer stage Ⅰ al, 70 patients were with stage Ⅰ a2 or advanced stages. The rate of positive margin was 1.11% ( 1/90), 3.83% ( 13/339), 10.70% (104/972), 26.24% (37/141),35. 63% (31/87) and 74.29% (52/70),respectively. There was statistic difference among them, except CIN Ⅰ and CIN Ⅱ . When combined CIN Ⅰ with CIN Ⅱ , then compared with CIN Ⅲ, cervical cancer withⅠ al and Ⅰ a2, it also showed statistical difference (P<0.05 ) . The rate of positive margin in postmenopausal women was 21.54% (28/130), which was significantly higher than 13.38% (210/1569)in premenopausal women (P=0.010 ). The logistic regression analysis showed that the procedure of excision, grade of disease, size of lesion, surface of cervix, and menopause were high risk factors associated with the positive margin, the risk ratio were 5.147, 3.048, 1.271, 1.905 and 1.860, respectively.Conclusions High grade, the extent of CIN disease, LEEP and postmenopausal age are high-risk factors associated with positive margin in patients treated by conization. It should be warranted in those patients when designing conization treatment.