早期宫颈癌的病理诊断取材方法和手术方式的探讨

ON THE METHODS OF BIOPSY AND MANAGEMENT OF EARLY SQUAMOUS CELL CARCINOMA OF THE UTERINE CERVIX

本文对宫颈原位癌151例和早期浸润癌42例进行分析。阴道镜下选点取材活检和碘不染区多点活检分别与锥切和子宫切除病理对照。前二者的癌漏诊率相近,为5.5%和4.3%;锥切为1.5%,但需住院手术,併发症较多.碘染后多点活检安全,可在门诊和基层使用,无需特殊设备。如同时刮取颈管高处能减少漏诊。一般情况下可用以代替锥切。治疗以手术为主。151例原位癌中单纯锥切治疗16例,2例复发;108例诊断性锥切后子宫切除,9.2%仍有残余病变。所以希望保留子宫者,锥切范围宜扩大并加强随诊。此外对早期浸润<1毫米,1~3毫米,3~5毫米者提出处理意见。

151 cases of carcinoma in situ and 42 of early invasive cancer of the uterine cervix were analyzed.The pathological results of the specimen taken by colposcopically directed biopsies and Schiller-directed multiple biopsies were compared with those obtained by conization and hysterectomy.The rate of missed diagnosis by the former two methods were 5.5%and 4.3%respectively,while that by conizations was 1.5%.The latter needs hospitalization and has more complications.Schiller-directed multiple biopsy method is simple and safe and can be performed in the outpatient service.If an endocervical curettage is performed at the same time,a higher rate of accuracy can be obtained and can be comparable to that of cenization.Treatment for these early malignancies is surgical.Among 151 eases of carcinoma in situ 16 cases treated with conization alone had 2 recurrences,and 108 cases treated with hysterectomy after diagnostic conization were found to have 10 cases with residual lesion(9.2%)on pathological examination.indicating the treatment by simple conization is not satisfactory.If the patient wants to preserve the uterus,an extended conization is recommended,and also should be closely followed.A working schedule for treatment of cervical carcinoma of early invasion less than 1 mm,and those between 1~3 mm,and 3~5 mm is suggested.