LEEP术后切缘阳性的高级别CIN绝经前患者病灶残留相关因素研究.pdfVIP

江医学2014 年第36 卷第12 期 LEEP 术后切缘阳性的高级别 CIN 绝经前患者病灶残留相关 因素研究 王国华 吴芬英 蒋建峰 【摘要 】 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20 13 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。 【关键词】 子宫颈上皮内瘤变 子宫颈线圈电切术 切缘阳性 Risk factors of residual lesions in premenopausal patients with high-grade cervical intraepithelial neoplasia of positive margins after LEEP China 【Abstract 】 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 20 12 at Affiliated Shaoxing Hospi- tal were retrospectively analyzed. All 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