文章基本信息

标题：Necessity for subsequent surgery in women of child-bearing age with positive margins after conization
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作者：Xinmei Wang ; Juan Xu ; Yang Gao 等
期刊名称：BMC Women's Health
印刷版ISSN：1472-6874
电子版ISSN：1472-6874
出版年度：2021
卷号：21
期号：1
页码：1-9
DOI：10.1186/s12905-021-01329-x
出版社：BioMed Central
摘要：20–25% of women with high-grade cervical intraepithelial neoplasias (HSIL) have residual lesions after conization. The state of the margin is generally considered to be a risk factor for recurrence or persistent lesions. Predictors of positive margins and residual lesions need to be identified. A design for postoperative management and avoidance of overtreatment needs to be provided, especially for women of child-bearing age. This study was a retrospective analysis of 1309 women of child-bearing age with HSIL, who underwent cold knife conization (CKC). Age, gravidity, parity, human papillomavirus (HPV) species, cytology, transformation zone type, results of endocervical curettage (ECC), quadrant involvement, glandular involvement, and Cervical Intraepithelial Neoplasia (CIN) grade were analyzed. Among those with positive margins, 245 patients underwent secondary surgery within three months, including CKC, a loop electrosurgical excision procedure, and total hysterectomy. Risk factors for positive margins and residual lesions were assessed. There was no significant difference in age, gravidity, parity, glandular involvement, and CIN grade between the two groups (P > 0.3). There was a significant difference in HPV species, cytology, ECC results, and quadrant involvement (P 35 years was also a risk factor for residual lesions (P < 0.03). High-risk women should be treated appropriately considering fertility. Patients with positive margins should be managed uniquely. Surgery for women without fertility may be appropriate. Close follow-up is necessary for women who have fertility requirements or are unwilling to undergo subsequent surgery if they have no risk factors, especially women < 35 years.
关键词：Cervical intraepithelial neoplasia (CIN) ; Women of child-bearing age ; Cold knife conization (CKC) ; Positive margins ; Residual lesions ; High-risk HPV