28例宫颈上皮内瘤样病变宫颈锥切术后再处理的临床分析

Clinical Analysis of Management of 28 Cases with Cervical Intraepithelial Neoplasia After Conization

【目的】探讨CIN锥切术后切缘阳性或高级别宫颈上皮内瘤样病变（CIN）病人的处理方法。【方法】回顾性分析2004年5月至2005年12月28例CIN普通电刀锥切术后再治疗的临床资料，并将锥切术后的病理与进一步治疗后病理进行分析比较。28例锥切病人中切缘阳性者10例，切缘阴性者18例。再治疗者采用子宫切除术26例（92．86％），宫颈锥切2例。【结果】全组再次术后标本中无病变者16例（57．15％），降级者7例（25．0％），相符者5例（17.85％）。锥切切缘阳性和阴性再次术后的宫颈残存病灶分别为60％（6／10）和33．33％（6／18），两者差异无显著性。锥切术后病理中3例浸润癌（1例腺癌，2例鳞癌），再次术后变为1例阴性，1例降级，1例腺癌深肌层漫润。锥切术后病理中发现5例微小浸润癌，再次术后2例降级，2例转阴，1例相符。20例高级别CIN（6例CIN2～3级、14例CIN3级）术后15％相符，20％降级，65％转阴。【结论】CIN锥切术后为浸润癌者，必须及时处理。术后为微小浸润癌和高级别的CIN、切缘阳性者，根据具体情况进一步处理。

[Objective]To investigate the treatments of selected cases with cervical intraepithelial neoplasia （CIN）after cervical conization with positive margins or high grade CIN. [Methods]A retrospective study was carried out to evaluate 28 cases with CIN who had been treated by conization with general electrosurgery and admitted in hospital from May 2004 to December 2005. Cone histologic diagnosis was compared with that of further treatment. Among 28 cases, positive margins were 10, while negative margins were 18. Further treatment included hysterectomy（ n = 26）, conization（ n = 2）. [Results]Sixteen out of 28 cases（ 57.14 % ） were diagnosed as no residual lesions after repeated operation, 7 cases（25.0 %）had lesions lower than that of conization , while 5 cases （ 17.85 % ） had lesions consistent with it. Residual lesions were found in 60 % cases（ 6/10） with positive margins and 33.33%（6/18）cases with negative margins. No significant difference existed between them. Three cases with invasive cervical cancer in cone margin were all retreated in which 2 were adenocarcinoma and involved myometrium,3 out of 5 cases with micro-invasive carcinoma had degraded and 2 had no residual lesions. Consistent,degraded,or negative disease was found in 15.0% ,20. 0% ,65. 0%of 20 cases with high grade CIN. [Conclusion]Cases with invasive cervical carcinoma after conization should be dealt with in time. Particularly for suspicious adenocarcinoma,this kind of patients should be diagnosed by conization. Cases with microinvasive carcinoma or high grade CIN after conization with positive margin should be further treated.