Predictive Factors for Residual Disease in Subsequent Hysterectomy Following Conization for CIN Ⅲ
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摘要: 目的 探讨宫颈锥切术后病灶残留的相关因素，为宫颈锥切术后的进一步诊疗提供依据。方法 对90例宫颈锥切术后(LEEP术和CKC术)再行全子宫切除的CINⅢ患者进行回顾性分析，探讨患者年龄、HPV感染情况、切缘状态、切缘阳性病变级别以及宫颈锥切方式与病灶残留之间的关系。结果 全部病例治疗后随访42~66月，未发现复发；55例（55/90，61.11%）患者的全宫标本中存在病灶残留；年龄>40岁组(33/47例，70.2%)与≤40岁组(22/43，51.2%)、HPV-H感染组(32/52，61.5%) 与HPV-H阴性组(1/2，50.0%)、LEEP术组(49/78，62.8%)与CKC术组(6/12，50.0%)的病灶残留率差异无统计学意义(P>0.05)；切缘阳性患者病灶残留率(38/53，71.7%)明显高于切缘阴性患者(17/37，46.0%，P<0.01)；切缘病变级别为CINⅡ-Ⅲ患者(27/33，81.8%)病灶残留率明显高于CINⅠ患者(11/20，55.0%，P<0.05)。结论 切缘阳性是CINⅢ病灶残留的危险因素，临床医师可以通过控制切缘阳性从而降低病灶残留，对于切缘阳性患者尤其是切缘高级别病变患者应考虑进一步的治疗及严密的随访。
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关键词:
- 子宫颈上皮内瘤样病变Ⅲ(CINⅢ) /
- 子宫颈锥形切除术 /
- 全子宫切除术 /
- 病灶残留
Abstract: Objective To explore predictive factors for post-cone residual disease in subsequent hysterectomy for cervical intraepithelial neoplasia(CIN)Ⅲ. Methods We determined the relationship between residual disease and clinical features, cone marginal status, CIN grade of positive cone margin, conization type by retrospectively reviewing 90 CINⅢpatients who received hysterectomy following cervix conization. Results All cases were followed up for 42-66 months and no recurrence was found. Residual disease was detected in 55 hysterectomy specimen (55/90, 61.11%). There was no significant difference of residual disease incidence between age >40 (33/47, 70.2%) and age ≤40(22/43, 51.2%), HPV-H positive(32/52, 61.5%) and negative(1/2, 50.0%), and LEEP(49/78, 62.8%) and CKC group (6/12, 50.0%) (P>0.05). The residual disease incidence in patients with positive cone margin (38/53, 71.7%)was higher than that with negative cone margin (17/37, 46.0%,P<0.01). The residual disease incidence in patients with cone margin of CINⅡ-Ⅲ(27/33, 81.8%) was higher than that of CINⅠ (11/20, 55.0%,P<0.05). Conclusion Positive cone margin, especially with high CIN grade, is the predictive factor for residual disease in subsequent hysterectomy following conization for CINⅢ and the patients should be attended to further treatment and closely following up. The clinicians could control the cone marginal status to reduce residual disease. -
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[1] Wu XF, Jiang WJ, Chen HZ. A control study of biopsy under colposcopy and pathology of hysterectomy specimen[J]. Hubei Yi Xue Yuan Xue Bao, 1992,13:230-5. [吴绪峰，蒋文俊，陈惠 祯. 阴道镜活检诊断与术后病理检查配对研究[J]. 湖北医学院 学报,1992,13:230-5.] [2] van Hamont D, van Ham MA, Struik-van der Zanden PH, et al. Long-term follow-up after large-loop excision of the transformation zone: evaluation of 22 years treatment of highgrade cervical intraepithelial neoplasia[J]. Int J Gynecol Cancer, 20 06, 16(2): 615-9. [3] American College of Obstetricians and Gynecologists. ACOG Practice Bulletin number 66, September 2005. Management of abnormal cervical cytology and histology[J]. Obstet Gynecol,2005,106(3): 645-64. [4] Lu CH, Liu FS, Tseng JJ, et al. Predictive factors for residual disease in subsequent hysterectomy following conization for CIN III[J]. Gynecol Oncol, 2000,79(2): 284-8. [5] Alonso I, Torné A,Puig-Tintoré LM, et al. Pre- and post-conization high-risk HPV testing predicts residual/recurrent disease in patients treated for CIN 2-3[J]. Gynecologic Oncology , 2006， 10 3(2): 631-6. [6] Jain S, Tseng CJ, Horng SG, et al. Negative predictive value of human papillomavirus test following conization of the cervix uteri[J]. Gynecol Oncol,2001,82(1): 177-80. [7] Narducci F, Occelli B, Boman F, et al. Positive margins after conization and risk of persistent lesion[J]. Gynecol Oncol, 2000, 76 (3): 311-4. [8] Fadare O, Cardoza-Favarato G. Signifi cance of disease extent in high-grade cervical intraepithelial neoplasia excised with negative margins by loop electrosurgical excision procedure[J]. Ann Diagn Pathol, 2008, 12(1): 17-20. [9] Sankasem A,Thavaramara T,Manusirivithaya S,et al.Tumor persistence in high grade squamous intraepithelial lesion patients with positive surgical margin post loop electrosurgical excision procedure[J].J Med Assoc Thai,2006, 89(7):934- 40. [10] Cardoza-Favarato G, Fadare O.High-grade squamous intraepithelial lesion(CIN 2 and 3)excised with negative margins by loop electrosurgical excision procedure: the significance of CIN 1 at the margins of excision[J]. Hum Pathol, 2007, 38(5): 78 1-6. [11] Tseng CJ,Liang CC,Lin CT, et al.A study of diagnostic failure of loop conization in microinvasive carcinoma of the cervix[J]. Gynecol Oncol, 1999, 73(1): 91-5.
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