冷刀宫颈锥切术诊治宫颈上皮内瘤变的临床分析

Diagnostic and therapeutic efficacy of cold knife conization for cervical intraepithelial neoplasia

目的 探讨冷刀宫颈锥切术对宫颈上皮内瘤变的诊断治疗作用,并评价其临床疗效.方法 回顾性分析因宫颈病变行宫颈细胞学检查异常行阴道镜下宫颈多点活检和宫颈锥切术的92例患者的临床资料,对比宫颈锥切术和阴道镜下宫颈多点活检的病理检查结果,分析冷刀宫颈锥切术的临床疗效和并发症.结果 两者病理完全符合68例(73.9%),不符合24例(26.1%).3例(3.3%)患者锥切边缘受累,复发率为1.1%,治愈率为98.9%.发现早期浸润癌2例,5例患者后行子宫切除术或扩大子宫切除术.冷刀宫颈锥切术的主要并发症为出血和宫颈管狭窄,发生率分别为4.3%(4/92)和1.1%(1/92).结论 宫颈锥切术较阴道镜下多点活检对宫颈上皮内瘤变的诊断更准确,并具有重要治疗作用.

Objective To evaluate the diagnostic and therapeutic efficacy of cold knife conization for cervical intraepithelial neoplasia(CIN),their postoperative histoligical findings and clinical outcomes. Methods We retrospectively analyzed 92 patients with cervical intraepithelial neoplasia(CIN),compared the histological findings between cervical conization and colposcopic multiple punch biopsies. Results Of the 92 cases, there was a correlation in histological findings between cervical conization and colposcopic multiple punch biopsies in 68 cases(73.9%), the other 24 cases(26.1%) did not correspond. Incomplete excision occurred in 3 cases(3.3%) of 92 patients with CIN lesion in the cone specimens, but failure rate (persistence or recurrence) was only 1.1%, the cure rate was 98.9%. Two cases of early invasive cancer were detected. Five cases had additional hysterectomy or semi-radical hysterectomy. The main complications associated with conization were haemorrhage and cervical stenosis.Bleeding occurred in 4.3% of our patients, and cervical stenosis occurred in 1.1% of our patients. Conclusions Cervical intraepithelial neoplasia was diagnosed more correctly by conization than multiple punch biopsies.Otherwise conization can play an important therapeutic role for cervical intraepithelial neoplasia and early invasive cancer.