子宫颈锥切术在子宫颈原位癌诊断和治疗中的价值

Evalution of Cervical Conization in Dianosis and Management of Ceivical Carcinoma in Situ

目的了解宫颈原位癌的临床特点及治疗方法,评价宫颈锥切在诊断和治疗宫颈原位癌的价值。方法回顾性分析2004年1月～2007年2月宫颈锥切病理诊断为宫颈原位癌65例的临床病理资料。结果(1)65例接受宫颈锥切术的患者中59例术前接受阴道镜检查及多点活检,46例(78.0%)两者病理检查符合;其余13例(22.0%)宫颈锥切术后病理检查较阴道镜下多点活检病变级别升高。(2)锥切术后接受进一步手术治疗的30例患者中,切缘阳性者与阴性者病变残留率比较差异有统计学意义(P<0.01)。宫颈锥切病理组织学诊断和最后诊断的符合率为98.5%。(3)宫颈锥切手术主要并发症为出血。宫颈锥切术中出血量中度者(估计出血量400～500ml)2例,术后阴道大量出血者(出血量>500ml)2例,占6.2%。术后并发宫颈管粘连者2例,占3.1%。结论宫颈锥切术在宫颈原位癌的诊断和治疗中具有举足轻重的价值,它不能被阴道镜下多点活检所取代。对于宫颈锥切边缘阴性的宫颈原位癌患者保留子宫是可以接受的。

Objective To evaluate the clinical value of cervical conization in diagnosis and management of cervical carcinoma in situ. Methods The clinic - pathological data of the 65 patients with cervical carcinoma in situ from Jan 2004 to Feb 2007 were analyzed retrospectively. Results （ 1 ） Of the 65 patients, 59 cases had received the colposcopical multiple biopsies before the cervical conization and there was a correlation in pathology between cervical conization and colposcopical multiple biopsies in 46 cases （78.0%） , but there was not much correspondence between cervical conization and colposcopical multiple biopsy in 13 cases （22.0%）. （2）30 patients were received hysterectomy or cervical conization again. Patients with positive margins were significantiy more likely to have residual disease than those with negative margins （ P〈0.01 ）. （ 3 ） Postoperative hemorrhage was main side effect for conization. 2 case had moderate and 2 cases had huge hemorrhage. The rate of hemorrhage was 6.2%. 2 cases（3.1% ） had cervical adhesions after the conization. Conclusions Cervical conization plays a very important role in diagnosis and management of cervical carcinoma in situ and it can not be instead of colposcopical multiple biopsies. It is acceptable to preserve fertility in cervical carcinoma in situ patients after cervical conization with negative margin.