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目的探讨冷刀锥切术切缘阴性的重度宫颈鳞状上皮内瘤变(HSIL)患者的预后影响因素。方法回顾分析1999年1月至2004年1月间,卫生部北京医院妇产科266例冷刀锥切手术切缘阴性的 HSIL 患者的临床资料,分析影响预后的因素,并随访治疗结局。其中宫颈上皮内瘤变(CIN)Ⅱ20例,CIN Ⅲ246例(包括原位癌82例);腺体累及者40例,无腺体累及者226例;257例检测高危型人乳头状瘤病毒(HPV)患者中,高危型 HPV 阳性244例,阴性13例。结果中位数随访时间46个月,总复发率为8.6%(23/266),无浸润癌发生。CIN Ⅱ患者中1例(5.0%,1/20)复发,CINⅢ患者(不包括原位癌)中9例(5.5%,9/164)复发,而82例原位癌中13例(15.8%,13/82)复发,原位癌与 CINⅡ及 CINⅢ(不包括原位癌)患者复发率比较,差异均有统计学意义(P<0.05)。腺体累及者中7例(17.5%,7/40)复发,无腺体累及者中16例(6.0%,16/226)复发,两者比较,差异有统计学意义(P<0.05)。高危型 HPV 阳性者中2l例(8.6%,21/244)复发,而13例高危型 HPV 阴性者中无一例复发,两者比较,差异有统计学意义(P<0.05)。结论冷刀锥切术切缘阴性的 HSIL 复发率低;病理分级高和腺体受累是影响疗效及预后的因素。
Objective To investigate the prognostic factors of patients with severe cervical squamous intraepithelial neoplasia (HSIL) with negative margin of cold-knife conization. Methods From January 1999 to January 2004, the clinical data of 266 HSIL patients with negative margins after cold knife conization were retrospectively analyzed. The factors affecting the prognosis were analyzed and the outcomes were followed up. Among them, CIN Ⅱ20 cases, CIN Ⅲ 246 cases (including carcinoma in situ in 82 cases); gland involving 40 cases, no gland involving 226 cases; 257 cases of high-risk human papillomavirus ( HPV) patients, high-risk HPV-positive 244 cases, negative in 13 cases. Results The median follow-up time was 46 months, with a total recurrence rate of 8.6% (23/266), with no invasive carcinoma. One (5.0%, 1/20) recurred in CIN II patients, and 9 (5.5%, 9/164) recurred in CINⅢ patients (excluding carcinoma in situ), whereas 13 of 82 (15.8% , 13/82) recurrence. The recurrence rates of carcinoma in situ versus CINⅡ and CINⅢ (excluding carcinoma in situ) were significantly different (P <0.05). Seven cases (17.5%, 7/40) recurred in the gland masses, and 16 cases (6.0%, 16/266) recurred in the absence of glandular masses. The difference was statistically significant (P <0.05). Among the high risk HPV positive cases, 21 cases (8.6%, 21/244) relapsed while none of the 13 cases of high risk HPV negative patients relapsed. The difference was statistically significant (P <0.05). Conclusions Cold-knife conization has a low recurrence rate of HSIL with negative margins. High pathological grade and gland involvement are the factors affecting the efficacy and prognosis.