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Federación Mexicana de Ginecología y Obstetricia, A.C.

2020, Número 09

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Ginecol Obstet Mex 2020; 88 (09)


Importancia de los márgenes quirúrgicos afectados en la conización uterina cervical

María-Ortiz JS, Álvarez-Silvares E, Bermúdez-González M, García LS, Pato MM, Couso CB

Idioma: Español
Referencias bibliográficas: 76
Paginas: 586-597
Archivo PDF: 266.22 Kb.


RESUMEN

Objetivo: Determinar la asociación entre los márgenes afectados con la persistenciarecurrencia de neoplasia intraepitelial cervical, persistencia del virus del papiloma humano y las reintervenciones.
Materiales y Métodos: Estudio de casos y controles anidado en una cohorte retrospectiva del Complexo Hospitalario Universitario de Ourense (enero 2010-octubre 2017). Criterio de inclusión: mujeres con al menos una revisión postintervención. Criterios de exclusión: mujeres sin evidencia de displasia de alto grado en la pieza de conización y a las que no se dio seguimiento. Variables de estudio: edad, tabaquismo, preservativo, anticonceptivos orales, vacunación contra VPH, persistencia-recurrencia de NIC y de VPH y reintervención. Se realizaron pruebas paramétricas y no paramétricas entre las variables.
Resultados: La cohorte se integró con 248 mujeres, de éstas 81 (32.6%) tuvieron afectación de los márgenes quirúrgicos en la conización. La inmunosupresión, el tabaquismo y la anticoncepción oral fueron las asociaciones más frecuentes en los márgenes afectados. El uso de preservativo y la vacunación contra VPH fueron significativamente más frecuentes en los márgenes libres. Los márgenes afectados reportaron mayor persistencia de VPH (50 vs 23.9%; OR 3.17 (1.90-5.26), p ‹ 0.001), enfermedad persistente-recurrente (47.2 vs 22.5%; OR 3.07 (1.84-5.12), p ‹ 0.001) y reintervenciones (40.2 vs 15.4%; OR 3.679 (2.094-6.463), p ‹ 0.028). El margen más afectado fue, en orden descendente, endocervical (55.6%), exocervical (25%) y ambos (19.4%).
Conclusiones: El margen afectado confiere un riesgo importante en la evolución de la infección por VPH y la recurrencia de la enfermedad.


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