浙江医学
浙江醫學
절강의학
ZHEJIANG MEDICAL JOURNAL
2014年
12期
1056-1059
,共4页
子宫颈上皮内瘤变%子宫颈线圈电切术%切缘阳性
子宮頸上皮內瘤變%子宮頸線圈電切術%切緣暘性
자궁경상피내류변%자궁경선권전절술%절연양성
Cervical cancer%LEEP%Positive margin
目的：探讨LEEP术后切缘阳性的高级别子宫颈上皮内瘤变（CIN）绝经前患者病灶残留的相关因素，为进一步诊疗提供依据。方法收集初次LEEP术切缘阳性并行二次手术的51例高级别CIN、绝经前患者的临床资料，并对其病灶残留及相关因素进行分析。结果二次手术患者术后病理提示CIN共19例，其病灶残留率为37.2%。年龄≤35岁者病灶残留率为17.6%，年龄＞35岁为47.1%，两者之间差异明显（P＜0.05）。术前子宫颈脱落细胞(LBC)检测提示高度上皮内病变的病灶残留率明显高于低度上皮内病变组（P＜0.05）。颈管搔刮物中提示病变存在者病灶残余率约72.7%，高于颈管搔刮物阴性者（P=0.006）。多因素logistic回归分析发现，LBC提示高度上皮内病变及颈管搔刮物阳性是与初次锥切切缘阳性病灶残留高度相关因素，其危险度分别为3.258、7.064。对51例二次手术患者随访至2013年6月，共2例复发，占3.92%。结论患者年龄、LBC结果及颈管搔刮物阳性与初次手术病灶残留有相关性，对于此类患者应予以高度重视。
目的：探討LEEP術後切緣暘性的高級彆子宮頸上皮內瘤變（CIN）絕經前患者病竈殘留的相關因素，為進一步診療提供依據。方法收集初次LEEP術切緣暘性併行二次手術的51例高級彆CIN、絕經前患者的臨床資料，併對其病竈殘留及相關因素進行分析。結果二次手術患者術後病理提示CIN共19例，其病竈殘留率為37.2%。年齡≤35歲者病竈殘留率為17.6%，年齡＞35歲為47.1%，兩者之間差異明顯（P＜0.05）。術前子宮頸脫落細胞(LBC)檢測提示高度上皮內病變的病竈殘留率明顯高于低度上皮內病變組（P＜0.05）。頸管搔颳物中提示病變存在者病竈殘餘率約72.7%，高于頸管搔颳物陰性者（P=0.006）。多因素logistic迴歸分析髮現，LBC提示高度上皮內病變及頸管搔颳物暘性是與初次錐切切緣暘性病竈殘留高度相關因素，其危險度分彆為3.258、7.064。對51例二次手術患者隨訪至2013年6月，共2例複髮，佔3.92%。結論患者年齡、LBC結果及頸管搔颳物暘性與初次手術病竈殘留有相關性，對于此類患者應予以高度重視。
목적：탐토LEEP술후절연양성적고급별자궁경상피내류변（CIN）절경전환자병조잔류적상관인소，위진일보진료제공의거。방법수집초차LEEP술절연양성병행이차수술적51례고급별CIN、절경전환자적림상자료，병대기병조잔류급상관인소진행분석。결과이차수술환자술후병리제시CIN공19례，기병조잔류솔위37.2%。년령≤35세자병조잔류솔위17.6%，년령＞35세위47.1%，량자지간차이명현（P＜0.05）。술전자궁경탈락세포(LBC)검측제시고도상피내병변적병조잔류솔명현고우저도상피내병변조（P＜0.05）。경관소괄물중제시병변존재자병조잔여솔약72.7%，고우경관소괄물음성자（P=0.006）。다인소logistic회귀분석발현，LBC제시고도상피내병변급경관소괄물양성시여초차추절절연양성병조잔류고도상관인소，기위험도분별위3.258、7.064。대51례이차수술환자수방지2013년6월，공2례복발，점3.92%。결론환자년령、LBC결과급경관소괄물양성여초차수술병조잔류유상관성，대우차류환자응여이고도중시。
Objective To investigate the risk factors of residual lesions in patients with high- grade cervical intraepithelial neoplasia (CIN) of positive resection margins after loop electrosurgical excision procedure(LEEP). Methods The clinical data of 51 premenopausal patients with high- grade CIN undergoing LEEP from January 2007 to June 2012 at Affiliated Shaoxing Hospi-tal were retrospectively analyzed. Al patients had positive resection margins in initial conization and underwent second surgery. The risk factors of residual lesions were analyzed. Results Histopathological results of the second operation showed that 19 cases out 51 patients (37.2%) had residual disease. The residual disease rate in patients aged≤35 year was 17.6% , while in those>35y was 47.1%(P<0.05). The residual disease rate in patients with preoperative liquid- based cytology (LBC) suggesting high- grade CIN was significantly higher than that in those with low- grade CIN(P=0.002). The residual rate in patients with endo-cervical curettage suggesting CIN was much higher than that in those suggesting negative residual lesions (P=0.006). Multivari-ate Logistic regression analysis showed that LBC suggesting a high- grade intraepithelial lesions (ASC- H,HSIL) and endocervical curettage suggesting CIN are closely associated with residual disease, with relative risks of 3.258 and 7.064, respectively. After second surgery al patients were fol owed up to June 2013, the recurrence was found in 2 cases with a recurrent rate of 3.92%. Conclusion Age>35 years, LBC showing ASC- H and HSIL and endocervical curettage suggesting CIN are risk factors associat-ed with residual lesions in patients with high- grade CIN of positive margins after LEEP.
