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目的探讨宫颈锥切术后切缘阳性的高级别宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)患者病灶残留的相关因素及其下一步临床处理。方法回顾性分析2007年1月至2014年10月于浙江大学医学院附属妇产科医院行宫颈锥切术切缘阳性并行二次手术的166例高级别CIN患者的临床资料。结果 166例患者二次手术后病理提示炎性改变112例,病灶残留54例,残留率32.5%(54/166)。年龄、绝经状态、初次宫颈锥切宽度及术前高危HPV DNA负荷量为相关因素,其中年龄、初次锥切宽度和术前高危HPV DNA负荷量与病灶残留高度相关。结论术前高危HPV DNA负荷量>1000 RLU/PC,初次锥切体积<1.93 cm3的患者发生病灶残留可能性大,切缘阳性患者有必要行二次手术,手术方式应个体化。
Objective To investigate the related factors of residual lesions in cervical intraepithelial neoplasia (CIN) patients with positive margins after cervical conization and its clinical treatment. Methods The clinical data of 166 high-grade CIN patients who underwent cervical conization with positive surgical resection at the Affiliated Obstetrics and Gynecology Hospital of Zhejiang University from January 2007 to October 2014 were retrospectively analyzed. Results The pathological changes of 166 patients after secondary surgery suggested that 112 patients had inflammatory changes, 54 patients had residual lesions and the residual rate was 32.5% (54/166). Age, menopausal status, initial cervical conization width and preoperative high-risk HPV DNA load were related factors, including age, initial conization width and preoperative high-risk HPV DNA load and residual disease height. Conclusions Preoperative high-risk HPV DNA load> 1000 RLU / PC, initial conization volume <1.93 cm3 in patients with the possibility of residual lesions, patients with positive margins need to undergo second surgery, the surgical approach should be individualized.