宫颈上皮内瘤样病变锥切术后复发的影响因素

Factors Influencing Recurrence of Cervical Intraepithelial Neoplasia after Conization

摘要: 宫颈上皮内瘤变(cervical intraepithelial neoplasia CIN)是一组与子宫颈浸润癌密切相关的子宫颈病变。在我国，宫颈癌发病高峰年龄在40~54岁之间，而CIN的发病高峰年龄在30~39岁之间，其发病年龄趋于年轻化，子宫颈癌住院患者平均发病年龄44.7岁，其中35岁及以下患者占16.0%，35~45岁患者占41.7%。为尽可能保留患者的生育功能，临床多采用宫颈锥切手术治疗CIN。临床治疗CIN的常用术式包括冷刀锥切术(cold knife conization CKC)和宫颈环形电切术(loop electrosuigical excision procedure LEEP)，但术后残留及复发率较高。因此，尽快分辨出有残留或复发倾向的高危患者，对改善患者的预后及进展为宫颈癌具有重要意义。此外，患者是否绝经、高危人乳头瘤病毒(high risk human papilloma virus, HR-HPV)感染、病理切缘状态、阴道微生态环境、行为因素(吸烟、HIV感染)均被认为是CIN患者术后复发的影响因素。本文就CIN患者锥切术后复发的高危影响因素进行综述。

Abstract: Cervical intraepithelial neoplasia is a group of cervical lesions closely related to invasive carcinoma of the cervix. In China, the peak age of cervical cancer onset is between 40 and 54 years old, while the peak age of CIN onset is between 30 and 39 years old, and the age of onset tends to be younger. The average age of onset of cervical cancer inpatients is 44.7 years old, among which patients aged 35 and below account for 16.0% and patients aged 35 to 45 account for 41.7%. In order to preserve the fertility function of patients as much as possible, cervical conization surgery is commonly used in clinical treatment of CIN. The common surgical procedures for CIN in clinical treatment include cold knife conization (CKC) and loop electrosuigical excision procedure (LEEP). However, postoperative residual and recurrence rates are high. Therefore, early identification of high-risk patients with residual or recurrent tendencies is of great significance for improving the survival rate and prolonging the prognosis of patients. In addition, patients are postmenopausal, high-risk human papilloma virus (HR-HPV) infection, pathological marginal status, vaginal microecological environment, and behavioral factors (smoking, HIV infection) were all considered to be postoperative recovery in CIN patients Influencing factors. This paper reviews the research progress on the main influencing factors of postoperative recurrence in CIN patients.