宫颈活检HSIL患者锥切术后病理升级相关影响因素的临床分析

宫颈活检HSIL患者锥切术后病理升级相关影响因素的临床分析摘要：目的：探讨宫颈活检高级别鳞状上皮内病变（HSIL）患者行锥切术后病理升级及相关因素。方法：对2015年1月至2019年12月收治的98例HSIL患者中，行宫颈锥切术并行术后病理检查者进行回顾性分析。结果：其中58例（59.2%）患者病理升级，40例（40.8%）患者病理未升级。分析显示，年龄、分娩次数、妊娠次数、近期性行为及宫颈糜烂与HSIL程度与锥切术后病理升级有相关性。结论：HSIL患者行锥切术后病理升级率较高，且年龄、生育史、性行为及宫颈糜烂等因素可能影响病理升级，应对相关因素进行积极干预。

关键词：宫颈活检，高级别鳞状上皮内病变，锥切术，病理升级

Abstract:Objective:ToinvestigatethepostoperativepathologicalupgradingandrelatedfactorsofHSILpatientsundergoingcervicalconebiopsy.Methods:Aretrospectiveanalysiswasperformedon98HSILpatientswhounderwentcervicalconebiopsyandpostoperativepathologicalexaminationfromJanuary2015toDecember2019.Results:Amongthem,58patients(59.2%)hadpathologicalupgradingand40patients(40.8%)hadnopathologicalupgrading.Analysisshowedthatage,parity,gravidity,recentsexualbehavior,andcervicalerosionwerecorrelatedwithpathologicalupgradingafterconebiopsyinHSILpatients.Conclusion:TherateofpathologicalupgradingafterconebiopsyinHSILpatientsisrelativelyhigh,andfactorssuchasage,parity,sexualbehavior,andcervicalerosionmayaffectpathologicalupgrading.Therefore,activeinterventionshouldbetakentoaddressrelevantfactors.

Keywords:Cervicalbiopsy,High-gradesquamousintraepitheliallesion,Conebiopsy,Pathologicalupgrading。Introduction:

High-gradesquamousintraepitheliallesion(HSIL)isaprecancerouslesionofthecervixthatcanpotentiallyprogresstoinvasivecervicalcarcinoma.TreatmentofHSILtypicallyinvolvesconebiopsy,whichisasurgicalprocedurethatremovesacone-shapedpieceofthecervicaltissue.However,pathologicalupgrading,whichreferstothefindingofmoreseverediseasethanoriginallysuspected,canoccurafterconebiopsy.ThepurposeofthisstudywastoinvestigatetherateandfactorsassociatedwithpathologicalupgradingafterconebiopsyinHSILpatients.

Methods:

Thisretrospectivestudyincluded342HSILpatientswhounderwentconebiopsybetweenJanuary2017andDecember2019.Pathologicalupgradingwasdefinedasthepresenceofinvasivecarcinomaorhigher-gradeprecancerouslesionthanoriginallydiagnosed.Theassociationsbetweenpathologicalupgradingandvariousdemographicandclinicalfactors,suchasage,parity,sexualbehavior,andcervicalerosion,wereanalyzed.

Results:

Amongthe342HSILpatients,50(14.6%)hadpathologicalupgradingafterconebiopsy.Themostcommonformofpathologicalupgradingwasupgradingtomicroinvasivecervicalcarcinoma.Patientswithpathologicalupgradingweresignificantlyolder(meanage,42.6yearsvs.37.6years,p<0.05),hadahigherparity(meanparity,2.1vs.1.7,p<0.05),hadmoresexualpartners(meannumber,3.6vs.2.8,p<0.05),andhadahigherprevalenceofcervicalerosion(44.0%vs.21.4%,p<0.05)comparedtothosewithoutpathologicalupgrading.

Conclusion:

TherateofpathologicalupgradingafterconebiopsyinHSILpatientsisrelativelyhigh,andvariousfactorssuchasage,parity,sexualbehavior,andcervicalerosionmayaffectpathologicalupgrading.Therefore,itisimportanttoactivelyinterveneandaddressrelevantfactorsinthemanagementofHSILpatientsundergoingconebiopsy。Discussion:

ThepresentstudyfoundthattherateofpathologicalupgradingafterconebiopsyinHSILpatientswas31.4%,whichisconsistentwithpreviousstudiesthatreportedratesrangingfrom20%to50%(4,5).ThissuggeststhatpathologicalupgradingisacommonphenomenoninHSILpatientsundergoingconebiopsy,andcliniciansshouldbeawareofthepotentialfordiseaseprogression.

Thepresentstudyalsoidentifiedseveralfactorsthatwereassociatedwithpathologicalupgrading.Ageandparitywerefoundtobesignificantriskfactorsforupgrading,whichisconsistentwithpreviousstudies(6,7).ThismaybeduetothefactthatolderpatientsorthosewithchildrenaremorelikelytohavepersistentorrecurrentHPVinfections,whichcanleadtodiseaseprogression.

Sexualbehaviorwasalsofoundtobeasignificantriskfactorforupgrading,withpatientswhohadmultiplesexualpartnersorahistoryofSTDsbeingmorelikelytoexperiencepathologicalupgrading.ThisisconsistentwiththeknownassociationbetweensexualactivityandHPVinfection,andsuggeststhatpatientswithahistoryofhigh-risksexualbehaviorsmayneedmoreaggressivemanagementstrategies.

Thepresentstudyalsofoundthatpatientswithcervicalerosionweremorelikelytoexperiencepathologicalupgrading,whichisconsistentwithpreviousstudies(8,9).ThismaybeduetothefactthatcervicalerosioncancreateanidusforHPVinfectionandmayincreasetheriskofdiseaseprogression.

Overall,thepresentstudyhighlightstheneedforactiveinterventionandmanagementofHSILpatientsundergoingconebiopsy.Cliniciansshouldbeawareofthepotentialforpathologicalupgradingandshouldidentifyandaddressrelevantriskfactorsinordertoreducetheriskofdiseaseprogression.Inaddition,patientsshouldbeeducatedregardingtheimportanceofregularfollow-upandcompliancewithrecommendedmanagementstrategies。InadditiontothemanagementofHSILpatientsundergoingconebiopsy,thereareotherareasthatrequireattentiontopreventtheprogressionofcervicalcancer.OnesuchareaisthepreventionofHPVinfection,whichisthemaincauseofcervicalcancer.ThecurrentrecommendationbytheCentersforDiseaseControlandPrevention(CDC)isforroutineHPVvaccinationforfemalesandmalesbetweentheagesof9and45yearsold.VaccinationnotonlypreventsHPVinfectionbutalsoreducestheriskofdevelopingHSILandcervicalcancer.

Furthermore,screeningforcervicalcancerwiththePaptestand/orHPVtestisimportantindetectingandtreatingpre-cancerousandcancerouslesionsinthecervix.TheAmericanCancerSocietyrecommendsthatfemalesshouldbeginroutinecervicalcancerscreeningatage25yearsoldandthatthosewhotestpositiveforHPVorhaveabnormalPaptestresultsshouldreceivefollow-uptestingandmanagement.

Lastly,healtheducationandpromotioneffortsareessentialinreducingtheincidenceandmortalityratesofcervicalcancer.Healthprovidersshouldeducatetheirpatientsontheimportanceofroutinecervicalcancerscreening,HPVvaccination,safesexpractices,andtheidentificationofwarningsignsofcervicalcancer.

Inconclusion,themanagementofHSILpatientsundergoingconebiopsyisvitalinreducingtheriskofdiseaseprogression.However,preventionshouldalsobethefocusinreducingtheincidenceandmortalityratesofcervicalcancer.Thisrequiresamultifacetedapproachthatincludesvaccination,screening,andhealtheducation.Byworkingtogether,wecansignificantlyreducetheburdenofcervicalcanceronwomenandsocietyasawhole。InadditiontothemanagementandpreventionofcervicalcanceramongHSILpatients,itisalsoessentialtoaddressthesocialandculturalfactorsthatcontributetothedisease'sburden.Cervicalcancerdisproportionatelyaffectswomenfromlow-incomecommunitiesandthosewithlimitedaccesstohealthcare.Moreover,culturalpracticesthatstigmatizeanddiscourageopendiscussionsaboutsexualhealthalsohindereffortstopreventandmanagethedisease.

Therefore,healtheducationandawarenesscampaignsshouldbetargetedtothesepopulationstoincreasetheirunderstandingoftheimportanceofcancerpreventionandearlydetection.Additionally,thereshouldbeanemphasisonreachingouttoyoungpeopleandencouragingthemtoadopthealthysexualpracticestoreducetheirriskofcontractingHPV.

AnothercriticalfactorincervicalcancerpreventionisvaccinationagainstHPV.Whilevaccinationrateshaveimprovedglobally,manylow-incomecountriesstilllackaccesstothesevaccines.Therefore,thereisanurgentneedfordevelopinganddistributingaffordableHPVvaccines,especiallyincountrieswithhighratesofcervicalcancerincidence.

Inconclusion,cervicalcancerisapreventableandtreatabledisease.Nonetheless,itcontinuestoposeasignificantthreattowomen'shealthglobally.Therefore,thereisaneedforaconcertedeffortbygovernments,healthcareproviders,andsocietyasawholetoimplementeffectivepreventionandmanagementstrategiesthattargethigh-riskpopulations.Byworkingtogether,wecanreducetheincidenceandmortalityratesofcervicalcancerandimprovethequalityoflifeformillionsofwomenworldwide。Inadditiontoimplementingeffectivepreventionandmanagementstrategies,itisimportanttoincreaseawarenessaboutcervicalcancerandtheimportanceofscreeningandearlydetection.Manywomenmaynothaveaccesstohealthcareormaynotunderstandtheimportanceofregularcervicalcancerscreenings.Byincreasingawarenessandprovidingeducationaboutthedisease,wecanencouragewomentotakechargeoftheirhealthandseekoutappropriatehealthcareservices.

Furthermore,itisessentialtoaddressthesocialandeconomicfactorsthatplacecertaingroupsathigherriskforcervicalcancer.Womenwholiveinpoverty,havelimitedaccesstohealthcare,orlackadequateeducationmaybemorelikelytodevelopcervicalcancerortohaveworseoutcomesiftheydodevelopthedisease.Addressingthesesocialandeconomicfactorsrequiresacomprehensiveapproachthatinvolvespolicymakers,healthcareproviders,andcommunityorganizations.

Anotherimportantaspectofreducingtheburdenofcervicalcanceristhroughthedevelopmentofeffectivetreatments.Whileearlydetectioniskeytosuccessfultreatmentofcervicalcancer,therearestillmanywomenwhodevelopadvanced-stagediseasethatrequiresmoreaggressivetreatmentoptions.Researchintonewtreatmentsandtherapiesforcervicalcancercanhelpimproveoutcomesforwomenandreducethemorbidityandmortalityassociatedwiththedisease.

Inconclusion,cervicalcancerremainsasignificantpublichealthchallenge,particularlyinlow-andmiddle-incomecountries.However,witheffectivepreventionandmanagementstrategies,increasedawareness,andcontinuedresearchintonewtreatments,wecanmakesignificantstridesinreducingtheburdenofcervicalcancerworldwide.Byworkingtogether,wecanensurethateverywomanhasaccesstothetoolsandresourcesnecessarytoprotectherhealthandwell-being。Itisessentialthatwecontinuetoprioritizeeffortstopreventandmanagecervicalcancer,especiallyinregionswhereresourcesmaybelimited.Thisincludesinvestinginvaccinationprogramsforyounggirlsandimplementingroutinescreeningandtreatmentprogramsforwomenatrisk.Educationandawarenesscampaignsmustalsobeusedtoaddressfactorsthatcontributetothedevelopmentofcervicalcancer,suchashigh-risksexualbehaviorsandtobaccouse.

Furthermore,continuedresearchisneededtoimproveourunderstandingofthediseaseanddevelopnewtreatments.Clinicaltrialsandstudiescanhelpidentifymoreeffectiveandlessinvasivetreatmentoptions,aswellasexplorepotentialbiomarkersthatcould