子宫颈冷刀锥切及成形术治疗宫颈上皮内瘤变临床分析

Clinical analysis of cervical intraepithelial neoplasia with cold knife conization and cervical plasty

目的:探讨子宫颈冷刀锥切及成形术在宫颈上皮内瘤变诊治中的应用价值。方法:回顾性分析2005年1月～2007年5月行子宫颈冷刀锥切及成形术的133例病例的相关资料。对术前阴道镜下宫颈多点活检的组织学结果与宫颈锥形切除术后的病理结果进行比较。结果:子宫颈锥形切除术后与术前阴道镜病理结果诊断完全相符者65例,占48.9%;不符合者68例,占51.1%。其中有30例(22.5%)宫颈锥切术后病理检查较阴道镜下多点活检程度重,38例(28.6%)程度较轻。手术平均时间为37.10min,平均出血量为34.77ml。术后有17例(占12.8%)局部少量出血,多发生在术后2～3天,8例(占6.02%)术后出现切口局部感染,抗炎治疗后恢复,2例(占1.5%)于术后10天、13天由于缝线脱落出现活动性出血。结论:子宫颈锥形切除术与阴道镜下活检病理诊断存在一定的差距,可以弥补阴道镜下活检的不足,且有治疗作用。在子宫颈锥切术基础上行成形术较传统的手术可以减少术中、术后出血。子宫颈冷刀锥切术是一项易操作、经济、实用的临床诊疗方法。

Objective： To explore the valuation of cervical cold knife conization and cervical plasty in the diagnosis and treatment of cervical intraepithelial neoplasia. Methods： A retrospective study was carried to evaluate 133 cases with cervical intraepithelial neoplasiafrom January 2005 to May 2007 to compara the pathological results between cervical knife conization （CgC） and colposcopic multiple biopsies （MB） . Results： Sixty-five out of 133 （48. 9% ） cases had the same pathological reports between MBand CKC, 68 cases had different resttlts. Among the 68 cases thirty （22. 5% ） cases pathological resttlts of CKC were in higher grade than those of MB. The average time of operation was 37. 10 minutes and the blood loss was 34. 77 ml. 17 （ 12. 8% ） cases had a litter blood loss. 2 cases （ 1. 5% ） had continued blooding because of suture fall off. 8 （ 6. 02% ） cases occurred inflammation after operation. Conclusion： There are certainly different diagnosis between MB and CKC. CKC can compensate partially the deficiency of colposcopic MB and play a therapeutic role. Cervical plasty can less the number of blood. CKC is a easily operating, economical and practical method.