자궁경부 원추절제술 후 절제연 양성인 환자에서 잔류병변의 예측인자
Positive Margins after Cervical Conization and the Predictive Factors of Residual Disease
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목적 : 원추절제술 후 절제연 양성인 환자에서 잔류병변과 관련된 예측인자에 대해 고찰해 보고자 하였다. 연구 방법 : 1988년 1월부터 2003년 12월까지 16년간 구로병원에서 시행한 원추절제술 환자들 735명 중 81명에서 절제연 양성을 보였고, 그 중에서 즉시 재수술이 시행되었거나 추적검사로 자궁경부 세포진검사, HPV 검사, 자궁경부 내막소파술, 질확대경검사 후에 재수술이 시행되었던 58명의 환자를 대상으로 후향적 연구를 시행하였다. 결과 : 환자들의 평균 연령은 44.5세였고, 58명의 환자들 중 27명 (46.6%)에서 잔류병변이 있었다. 원추절제술 조직의 중증도는 잔류병변의 예측인자로 유의하였다 (p<0.05). 환자들의 연령, 절제연 위치는 잔류병변의 예측인자로 유의하지 않았다. 그러나 자궁경부 세포진검사, HPV 검사, 자궁경부 내막소파술, 질확대경하 조준생검은 더 많은 예를 대상으로 한 연구가 필요할 것으로 사료된다. 결론 : 원추절제술 조직의 중증도는 원추절제술 후 절제연 양성인 환자에서 예측인자로 유용하다.
Abstract
Objective : The aim of this study was to evaluate the predictive factors of residual disease for positive conization margins. Methods : Retrospective study was performed in 735 patients treated with bovie electroknife conization at the University Hospital of Kuro between January, 1988 and December, 2003. Of the 735 patients, 81 patients (11.0%) had positive margins after conization. 58 of these 81 patients underwent either immediate reoperation or monitoring with a Pap smear, HPV test, endocervical curettage and colposcopy. Fisher exact test, Trend test were used for statistical analysis. Results : The mean age of the patients was 44.5 years. 27 of 58 patients (46.6%) undergoing conization followed by reoperation had residual lesion in the specimen obtained by reoperation. Severity of lesion was associated with the predictive factors of residual disease (p<0.05). Age of patients, site of resection margins were not associated with the predictive factors of residual disease. But more sufficient number of cases of Pap smear, HPV test, endocervical curettage and colposcopy directed biopsy are thought to be needed for stastistical analysis. Conclusion : Severity of lesion is useful in predicting residual disease for positive conization margins.
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