锥切范围对高级别宫颈上皮内瘤变锥切术后复发的影响

石卓鑫; 令狐华

doi:10.16016/j.1000-5404.201704085

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锥切范围对高级别宫颈上皮内瘤变锥切术后复发的影响

临床医学 | 更新时间：2026-01-09

- 锥切范围对高级别宫颈上皮内瘤变锥切术后复发的影响
- Cone size: an innegligible factor to predict recurrence or persistence of high-grade cervical intraepithelial neoplasia following conization
- 第三军医大学学报 2017年39卷第20期页码：2035-2041
- 作者机构：
  
  400046 重庆, 重庆医科大学附属第一医院妇产科
- 作者简介：
  
  [令狐华, E-mail:linghu_hua@yahoo.com LINGHU Hua, E-mail:linghu_hua@yahoo.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201704085
  中图分类号： R181.32;R730.56;R737.33
- 收稿：2017-04-18，
  
  修回：2017-05-28，
  
  纸质出版：2017-10-30
- 稿件说明：
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石卓鑫, 令狐华. 锥切范围对高级别宫颈上皮内瘤变锥切术后复发的影响[J]. 第三军医大学学报, 2017,39(20):2035-2041.

Zhuoxin SHI, Hua LINGHU. Cone size: an innegligible factor to predict recurrence or persistence of high-grade cervical intraepithelial neoplasia following conization[J]. Journal of Third Military Medical University, 2017, 39(20): 2035-2041.
石卓鑫, 令狐华. 锥切范围对高级别宫颈上皮内瘤变锥切术后复发的影响[J]. 第三军医大学学报, 2017,39(20):2035-2041. DOI： 10.16016/j.1000-5404.201704085.

Zhuoxin SHI, Hua LINGHU. Cone size: an innegligible factor to predict recurrence or persistence of high-grade cervical intraepithelial neoplasia following conization[J]. Journal of Third Military Medical University, 2017, 39(20): 2035-2041. DOI： 10.16016/j.1000-5404.201704085.

摘要

目的

探索高级别宫颈上皮内瘤变(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(

：7.094

95%

：1.350~37.279，

=0.021)。手术中锥切宽度小于1.77 cm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%

：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%

：0.492~0.886)。此外，高危HPV感染(

：8.674，95%

：1.047~ 71.862)、阴道分娩≥2次(

：10.708，95%

：1.543~74.322) 亦为复发危险因素(

0.05)。

结论

锥切范围不够是高级别宫颈上皮内瘤变的复发高危因素，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。

Abstract

Objective

To investigate the risk factors for persistence or recurrence of high-grade cervical intraepithelial neoplasia (CIN) after conization in order to guide cone size and postoperative follow-up plan.

Methods

Clinical data of 113 patients who received cervical conization for hgCIN in our department between August 2013 and June 2016 were collected and reviewed retrospectively. The correlation of clinicopathological parameters and postoperative recurrence was analyzed. The median follow-up time was 19 months (ranging from 2 to 39 months).

Results

Recurrence occurred in 9 patients during the follow-up period. Multivariate analysis showed specimen thickness (cone width) was closely associated with CIN recurrence (

: 7.094

95%

: 1.350~37.279

=0.021). When the cone width less than 1.77 cm

the area under the receiver operating characteristic (ROC) curve (AUC) was 0.81 (95%

: 0.650~ 0.971)

with sensitivity and specificity of 88.9% and 83.8%

respectively. When the cone depth less than 2.24 cm

the AUC of ROC curve was 0.689 (95%

0.492~0.886)

with sensitivity and specificity of 44.4% and 87.9%

respectively. Additionally

high risk HPV infection (

: 8.674

95%

: 1.047~71.862)

and vaginal delivery ≥2 times (

: 10.708

95%

: 1. 543~74.322) were predictive factors for CIN recurrence.

Conclusion

Cone size not wide or deep enough is an innegligible high risk factor for recurrence of high-grade CIN after cervical conization

so wider and deeper conization is suggested. For those with high risk HPV infection

multiple vaginal delivery

small conization (cone width < 1.77 cm

cone depth < 2.24 cm)

close follow-up is recommended

including cervical cytology

HPV genotyping and colposcopy.

关键词

Keywords

references

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