论著
宫颈HSIL行锥切术后病灶残留高危因素及子宫切除时机探讨
王三锋 胡克 钟沅月 麦碧 何裕 张煦 黎玉涵
【摘要】 【摘要】目的 探讨宫颈高级别鳞状上皮内病变行宫颈锥切锥切术后病变残留的危险因素及子宫切除术的时机。方法 收集2015年1月至2017年12月在广东省妇幼保健院因宫颈高级别鳞状上皮内病变行宫颈锥切后再行子宫切除患者的临床资料；统计子宫切除前后病理结果、术后半年及术后1年HPV转阴情况；分析年龄、HPV类型、宫颈转化区类型、切缘状态、宫颈补切状态对病变残留的影响。
【关键字】 宫颈鳞状上皮内病变,子宫切除术,宫颈锥切术,病变残留,危险因素
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[Abstract] Objective To analyze the risk factors of residual lesions after conization of cervical high-grade squamous intraepithelial lesions and to explore the time of hysterectomy. Methods The clinical data of patients undergoing hysterectomy after conization of cervix due to cervical high-grade squamous intraepithelial lesions in Guangdong Women and Children Hospital from January 2015 to December 2017 was collected. The pathological manifestations before and after hysterectomy were compared and the regression condition of HPV 6 months and 1 year after hysterectomy was recorded. The effects of age, HPV type ,cervical transformation zone type, incision margin state and endocervical incision state on the residual disease were analyzed. Result Among the 107 cases performed with hysterectomy （64 cases with positive resection margin, 43 cases with negative resection margin）, the incidence rate of residual lesions in positive resection margin group（27.91%） and negative resection margin group（50.00%） had significant difference （P=0.0378）. Postoperative pathological upgrading occurred in 3 cases, all of which were found to be stage IA1 cervical cancer. The multivariate analysis showed that positive margin of cervical incision was a high risk factor for residual disease [OR=2.469 （95% CI 1.05-5.83）]. There was no significant difference on residual disease in groups of age, HPV type, type of transformation zone and endocervical incision state. Conclusion Positive resection margin is a high risk factor for the occurrence of residual lesions after HSIL conization. Pathological examination of the cervical conization samples should be performed before hysterectomy.
宫颈癌是妇科常见恶性肿瘤之一，随着宫颈癌筛查普及，临床中癌前病变的发现大幅增加。宫颈癌前病变传统病理命名是宫颈上皮内瘤变三级（CINⅠ、Ⅱ、Ⅲ），2012年ASSCP提出用两级分类法代替三级分类法来命名宫颈癌前病变，即低级别鳞状上皮内病变（low-grade squamous intraepithelial lesion，LSIL）和高级别鳞状上皮内病变（high-grade squamous intraepithelial lesion，HSIL）[1]，两级分类法弥补了以前三级分类法的不足[2]。宫颈LSIL约90%可自然消退，无需治疗，随诊即可；宫颈HSIL进展为宫颈癌的风险有20%左右，应积极治疗。宫颈锥切是宫颈HSIL有效治疗手段，锥切术后病变有残留风险，影响因素有争议；子宫切除术是宫颈HSIL的选择之一，手术选择时机也有一定争议[3-4]。本研究选择广东省妇幼保健院2015年1月至2017年12月因宫颈HSIL行切除子宫者作为研究对象，探讨宫颈HSIL宫颈锥切术后病变残留的危险因素及子宫切除术的手术时机。
