【摘要】 目的探讨因宫颈高度上皮内病变行宫颈锥切手术后病理切缘阳性患者的分层管理方式。方法回顾性分析2013年6月1日—2019年6月1日因宫颈高度上皮内病变(HSIL)在我院行宫颈锥切手术3 614例患者的病理资料,对术后病理切缘阳性的患者治疗及预后情况进行分析,比较术后病灶残留组与无病灶残留组患者的临床病理特征。结果宫颈锥切术后切缘阳性率为7.3%(266/3 614),将切缘阳性266例患者分为随诊组(142例)及治疗组(124例)。治疗组患者结合病变级别及患者生育需求分别采用了再次宫颈锥切术、全子宫切除术或广泛子宫切除术,再次术后病理诊断慢性宫颈炎45例,宫颈低度上皮内瘤变(LSIL)15例,HSIL 30例,宫颈癌34例,LSIL及以上病变患者占63.7%(79/124)。单因素分析显示,多点切缘阳性、内外切缘阳性、术后HPV持续感染与病灶残留有关(χ~2=6.231～13.774,P<0.05)。结论宫颈锥切术后病理切缘阳性患者需根据有无生育需求及病灶残留高危因素综合评估。具有病灶残留高危因素者,建议结合患者生育要求再次行锥切术或全子宫切除术。无病灶残留高危因素者,可优先选择严密随访,避免过度诊疗。宫颈锥切后诊断为浸润癌者则应按照指南行规范化治疗。更多还原

【Abstract】 Objective To investigate the hierarchical management model of patients with positive pathological margin after conization of the cervix due to high-grade squamous intraepithelial lesion(HSIL). Methods A retrospective analysis was performed for the pathological data of 3 614 patients who underwent conization of the cervix due to HSIL in our hospital from June 1, 2013 to June 1, 2019, and the treatment and prognosis of patients with positive pathological margin after surgery were analyzed. Clinicopathological characteristics were compared between the residual lesion group and the non-residual lesion group. ResultsThe rate of positive margin after conization of the cervix was 7.3%(266/3 614), and the 266 patients with positive margin were divided into follow-up group with 142 patients and treatment group with 124 patients. The patients in the treatment group received conization of the cervix again, total hysterectomy, or radical hysterectomy based on the grade of lesion and their requirements for childbearing; postoperative pathology showed that there were 45 patients with chronic cervicitis, 15 patients with low-grade squamous intraepithelial lesion(LSIL), 30 patients with HSIL, and 34 patients with cervical cancer, and the patients with LSIL or above accounted for 63.7%(79/124). The univariate analysis showed that positive margin of multiple incisions, positive margin of internal and external incisions, and persistent human papillomavirus infection after surgery were associated with residual lesion(χ~2=6.231-13.774,P<0.05). Conclusion Patients with positive pathological margin after conization of the cervix need to be comprehensively evaluated based on the presence or absence of requirements for childbearing and high-risk factors for residual lesion. For patients with high-risk factors for residual lesion, it is recommended to perform conization of the cervix again or total hysterectomy according to the patient’s requirements for childbearing; for patients without high-risk factors for residual lesion, follow-up can be performed first to avoid excessive diagnosis and treatment. Patients diagnosed with invasive carcinoma after conization of the cervix should be given standardized treatment according to guidelines.更多还原