宫颈锥切诊治CINⅢ和宫颈癌Ⅰ_(A1)期临床观察

Cervical Conization for Treatment of CIN 3 and Cervical Carcinoma StageⅠA1

[目的]探讨宫颈锥切对宫颈上皮内瘤变(CIN)Ⅲ及宫颈癌ⅠA1期的诊治作用。[方法]回顾性分析2002年1月至2004年12月行宫颈锥切术的114例患者的临床资料。[结果]宫颈锥切前多点活检准确率为87.7%(100/114)。宫颈粘连狭窄率为3.2%。21例患者补充全子宫切除术,切缘阳性者标本残留率为28.6%(2/7)、阴性者则为14.3%(2/14)。中位随诊16个月,仅行锥切术的93例患者(切缘阳性者2例、切缘阴性者91例),1例切缘阴性者复发(占1.1%)。11例患者有生育要求,已妊娠9例(81.8%),其中早产率为12.5%(1/8)。[结论]宫颈锥切是一种并发症少的手术方法,可提高CINⅢ、宫颈癌ⅠA1期的诊断准确性并有治疗作用。锥切治疗后复发率低,切缘阳性者易有残留,术后应适当处理及密切随诊。

[Purpose] To explore the value of cervical conization in diagnosis and management of CIN 3 Ⅲ and cervical carcinoma stage ⅠA1, [Methods] A retrospective analysis was carried out in 114 cases undergoing cervical conization between January 2002 and December 2004 at Cancer Center of Sun Yat-Sen University. [Results] The coincidence rate of the multiple biopsies before the procedures comparing with the eonization ones was 87.7%（79/114）. The rate of cervical stenosis was 3.2%.Twenty-one cases received subsequent hysterectomy, The incidence of residual disease was 28,6% （2/7） and 14,3%（2/14） respectively in patients with positive margins and negative margins. The medium follow-up time was 16 months. Among the 93 cases （2 with positive margin, 91 with negative margin） who received conization only , 1 case with clear margin recurred . Among the 11 cases desired childbearing,9 cases（81.8%） got pregnancy, and the premature birth rate was 12.5%（1/8）.[Conclusion] Cervical conization is a method with less complication and can improve both the diagnosis and treatmeant of CIN 3 and cervical carcinoma stage ⅠA1. Though few recurrence occurred postoperation,we should follow up closely and offer further treatment properly to the cases with positive margin because of the oersistent lesions.