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目的 探索高级别宫颈上皮内瘤变(high grade of cervical intraepithelial neoplasia,CIN)术后复发/持续危险因素,以指导确定锥切范围及制定术后随访计划。方法 回顾性分析2013年8月至2016年6月于我院妇科病房行锥切治疗并诊断为高级别宫颈上皮内瘤变的113例,分析其临床病理特征与术后复发的关系。随访时间2~39个月,中位随访时间19个月。结果 113例患者中有9例复发,多因素分析提示标本厚度(锥切宽度)与术后复发密切相关(HR:7.094,95%CI:1.350~37.279,P=0.021)。手术中锥切宽度小于1.77cm时,其预测术后复发灵敏度为88.9%,特异度为83.8%,曲线下面积(AUC)为0.81(95%CI:0.650~0.971);锥切深度小于2.24 cm时,预测复发灵敏度为44.4%,特异度为87.9%,曲线下面积(AUC)为0.689(95%CI:0.492~0.886)。此外,高危HPV感染(HR:8.674,95%CI:1.047~71.862)、阴道分娩≥2次(HR:10.708,95%CI:1.543~74.322)亦为复发危险因素(P<0.05)。结论 锥切范围不够是不可忽视的复发高危因素,建议尽可能行深宽锥切,对合并高危HPV感染、多次阴道分娩、锥切宽度小于1.77 cm、锥切深度小于2.24 cm者,术后需联合宫颈细胞学、HPV基因分型和阴道镜密切随访。
Objective To explore the postoperative recurrence / persistent risk factors of high grade of cervical intraepithelial neoplasia (CIN), so as to guide the determination of conization range and to make a postoperative follow-up plan. Methods A retrospective analysis was performed on 113 cases diagnosed as high grade cervical intraepithelial neoplasia by gynecological ward in our hospital from August 2013 to June 2016. The clinical and pathological features were analyzed retrospectively. Follow-up time was 2 to 39 months, with a median follow-up of 19 months. Results Nine of 113 patients relapsed. Multivariate analysis showed that the thickness of the conoid (taper width) was closely related to the recurrence (HR: 7.094, 95% CI: 1.350 ~ 37.279, P = 0.021). The predicted postoperative recurrence sensitivity was 88.9% with a specificity of 83.8% and the area under the curve (AUC) was 0.81 (95% CI: 0.650-0.971) when the taper width was less than 1.77 cm. The conical cut depth was less than 2.24 cm , The predicted recurrence sensitivity was 44.4% with a specificity of 87.9% and the area under the curve (AUC) was 0.689 (95% CI: 0.492-0.886). In addition, high risk HPV infection (HR: 8.674, 95% CI: 1.047 to 71.862) and vaginal delivery ≥2 (HR: 10.708, 95% CI: 1.543 to 74.322) were also risk factors for recurrence (P <0.05). Conclusions The conization range is not enough to be a risk factor for recurrence. It is advisable to perform deep conization as long as possible. For combined high-risk HPV infection, multiple vaginal deliveries with a conical cut width of less than 1.77 cm and a conical cut depth of less than 2.24 cm, postoperative Cervical cytology should be combined, HPV genotyping and colposcopy close follow-up.