| 摘要: |
| 目的探讨宫颈微小浸润癌（MIC）宫颈锥切术后子宫病灶残留的影响因素。方法收集经宫颈锥切术后病理明确诊断为MIC并在3个月内进一步行子宫切除术的患者149例，将其年龄、绝经情况、临床分期、术前血清鳞状细胞癌抗原（SCC）检测数值、术前阴道分泌物HPV分型检测结果等与宫颈切缘情况及子宫全切标本的病理结果相结合进行分析，探讨病灶残留的影响因素。结果有无子宫病灶残留的患者在年龄、是否绝经、临床分期、术前SCC水平和浸润情况的比较差异均无统计学意义（均P＞0.05），而在宫颈切缘和HPV16/18感染是否阳性的比较差异均有统计学意义（均P＜0.05）。多因素logistic回归分析结果显示，HPV16/18阳性为子宫病灶残留的独立危险因素（OR=3.999，P=0.002）。有无子宫病灶残留者HPV单种感染的比例差异无统计学意义（P＞0.05）。宫颈切缘阳性与阴性者的HPV16/18阳性率的比较差异有统计学意义（P＜0.05）。结论术前高危HPV16/18感染以及宫颈切缘阳性均与子宫病灶残留密切相关，HPV16/18感染为子宫病灶残留的独立危险因素。修改诊断切缘阴性的标准是否能更准确判断病灶残留情况以及是否需要扩大术前高危HPV16/18亚型感染患者的锥切手术范围有待进一步研究。 |
| 关键词: MIC 宫颈锥切术 宫颈切缘 人类乳头瘤病毒 病灶残留 |
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| Risk factors of residual neoplasia after conization for microinvasive cervical cancer |
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ZHANG Jiejie, ZHANG Ping
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Zhejiang Carcer Hospital
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| Abstract: |
| Objective To explore the risk factors on residual neoplasia after conization for microinvasive cervical cancer (MIC). Methods Clinical data of 149 patients who were diagnosed as MIC after conization and further received hysterectomy in three months were retrospectively reviewed. The association of residual neoplasia after conization with age, menopausal status, clinical course, preoperative serum squamous cell carcinoma antigen (SCC) and preoperative HPV genotyping was analyzed. Results There were on significances in age, menopausal status, stages, preoperative serum SCC or infiltration between patients
with residual neoplasia and those without residual neoplasia (all P ＞0.05), while the surgical margins of the cone and HPV16/18
infection were significantly associated with the residual neoplasia (all P ＜0.05). Multivariate Logistic regression analysis demonstrated that HPV16/18 was a significant predictor of residual disease (OR=3.999, P=0.002). There was no significant difference in infection of single or multiple types of HPV between the residual and non-residual groups (P ＞0.05). There was significant difference in HPV16/18 positivity between patients with positive cone margin and those with negative cone margin (P＜ 0.05). Conclusion Preoperative high risk HPV16/18 infection and cone margin positivity are significantly associated with residual disease, and HPV16/18 is an independent risk factor for residual disease in cervical MIC patients after conization. |
| Key words: Microinvasive cervical cancer Conization Cone margin HPV Residual neoplasia |
