| 陈见美,符永帅,周冬梅,赖 婷,生秀杰.宫颈冷刀锥切术治疗宫颈上皮内瘤变的疗效观察及术后切缘阳性的危险因素分析[J].,2020,(1):135-139 |
| 宫颈冷刀锥切术治疗宫颈上皮内瘤变的疗效观察及术后切缘阳性的危险因素分析 |
| Observation of Curative Effect of Cold Knife Conization for Cervical Intraepithelial Neoplasia and Analysis of Risk Factors for Positive Margin after Operation |
| 投稿时间：2019-04-25 修订日期：2019-05-21 |
| DOI：10.13241/j.cnki.pmb.2020.01.030 |
| 中文关键词: 宫颈上皮内瘤变 宫颈冷刀锥切术 宫颈环形电切术 疗效 切缘阳性 危险因素 |
| 英文关键词: Cervical intraepithelial neoplasia Cold knife conization of cervix Circular electrotomy of cervix Curative effect Positive rate of incision margin Risk factors |
| 基金项目:广东省医学科研基金项目（A2014319） |
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| 中文摘要: |
| 摘要 目的：探讨宫颈冷刀锥切术(CKC)治疗宫颈上皮内瘤变(CIN)的疗效，并分析术后切缘阳性的危险因素。方法：回顾性分析2009年1月至2017年12月在广州医科大学附属第三医院接受治疗的509例CIN患者的临床资料，其中行CKC治疗的患者318例记为CKC组，行宫颈环形电切术(LEEP)治疗的患者191例记为LEEP组，对比两组患者的手术指标、术后并发症发生率、切缘阳性率以及复发率，根据所有患者术后病理检查结果将其分为切缘阳性组和切缘阴性组，采用单因素和多因素Logistic回归分析方法分析CIN患者术后切缘阳性的危险因素。结果：CKC组患者的手术时间、住院时间均长于LEEP组患者，术中出血量多于LEEP组患者，组间比较差异有统计学意义(P<0.05)。CKC组患者的术后并发症发生率、切缘阳性率、复发率均低于LEEP组患者，组间比较差异有统计学意义(P<0.05)。单因素分析显示，切缘阳性组的手术方式、人类乳头状瘤病毒(HPV)感染、CIN病变分级、有无宫颈上皮腺体受累与切缘阴性组比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示，手术方式为LEEP、HPV感染呈阳性、CIN病变分级为III级、有宫颈上皮腺体受累是CIN术后切缘阳性的危险因素(P<0.05)。结论：采用CKC治疗CIN能够降低患者术后切缘阳性率和复发率，安全可靠。手术方式为LEEP、HPV感染呈阳性、CIN病变分级为III级、有宫颈上皮腺体受累是CIN术后切缘阳性的危险因素，在治疗过程中应重视以上危险因素，并采取针对性措施以降低CIN术后切缘阳性的发生率。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the efficacy of cold knife conization (CKC) in the treatment of cervical intraepithelial neoplasia (CIN), and the risk factors of positive margin after operation. Methods: The clinical data of 509 patients with CIN who were treated in the Third Affiliated Hospital of Guangzhou Medical University from January 2008 to July 2017 were retrospectively analyzed.318 patients treated with CKC were classified as CKC group, 191 patients treated with cervical circumferential electrotomy (LEEP) were recorded as LEEP group. The operative indexes, the incidence rate of postoperative complications, the positive rate of incision margin and the recurrence rate were compared between the two groups. The patients were divided into positive margin group and negative margin group according to the results of pathological examination after operation. The univariate and multivariate logistic regression analysis was used to analyze the risk factors of positive incision margin in patients with CIN. Results: The operation time and hospitalization time of CKC group were longer than those of LEEP group, the intraoperative bleeding volume was more than that in LEEP group, there were significant differences between groups (P<0.05). The postoperative complications, positive incision margins and recurrence rates in CKC group were lower than those in LEEP group, there were significant differences between groups (P<0.05). Univariate analysis showed that there were significant differences in surgical methods, human papillomavirus (HPV) infection, CIN grading, accumulative involvement of cervical epithelial glands between positive margin group and negative margin group (P<0.05). Multivariate logistic regression analysis showed that LEEP, positive HPV infection, grade III CIN lesions and accumulative involvement of glands in cervical epithelium were risk factors for positive incision margin after CIN(P<0.05). Conclusion: CKC treatment of CIN can reduce the positive rate of incision margin and recurrence rate, which is safe and reliable. The LEEP, HPV infection, CIN grade III and cervical epithelial gland involvement are the risk factors of positive incision margin after CIN. In the course of treatment, we should pay attention to the above risk factors and take appropriate measures to reduce the incidence of positive incision margin after CIN. |
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