【摘要】 目的探讨高级别宫颈上皮内瘤变(CIN)宫颈锥切术后病理升级的多因素及临床处理措施。方法选取2015年1月～2017年12月我院收治的77例高级别CIN宫颈锥切术患者作为研究对象,上述患者中25例术后病理升级,52例未有术后病理升级,对上述患者的临床资料进行回顾性分析,总结导致术后病理升级的因素及相应的处理措施。结果术后病理升级患者的年龄45岁以上占比、绝经占比、阴性部位宫颈管占比明显高于未有术后病理升级组,差异有统计学意义(P<0.05);年龄、人乳头瘤病毒(HPV)DNA水平等同术后病理升级成正相关关系;出现病理升级占32.47%,未出现的占67.53%,另外有11例患者接受二次手术治疗。结论病理升级同患者的年龄、HPV DNA水平、初次宫颈锥切的宽度、绝经状态和阴性部位等因素有密切关联,上述因素中,患者的年龄、绝经状态、HPV DNA水平及阴性部位等属于高危因素。临床中对切缘阳性患者应开展个体化的二次手术治疗。更多还原

【Abstract】 Objective To investigate and analyze the multi-factors and clinical management measures of high-grade cervical intraepithelial neoplasia(CIN) after cervical conization. Methods A total of 77 patients with high-level CIN after cervical conizatio after admitted to our hospital from January 2015 to December 2017 were enrolled. Of these, 25 patients had postoperative pathological escalation, and 52 patients had no postoperative pathological escalation. The clinical data were retrospectively analyzed to summarize the factors leading to postoperative pathological escalation and the corresponding treatment measures. Results The age of patients over 45 years old, the proportion of menopause, and the proportion of cervical tube in the negative site were significantly higher than those without postoperative pathological improvement(P<0.05). Age and human papillomavirus(HPV) DNA levels were positively correlated with pathological upgrading after operation. At the same time, pathological changes accounted for 32.47%, and 67.53% did not appear.In addition, 11 patients underwent secondary surgery. Conclusion Pathological escalation are closely related to the patient’s age, levels of HPV DNA, width of primary cervical conization, menopausal status and negative site. Among the above factors, age, menopausal status, HPV DNA levels and negative part and so on are high risk factors. In the clinical practice, patients with positive margins should undergo individualized secondary surgery.更多还原