CINⅢ和早期浸润癌冷刀锥切术后病变残存的病理分析

Analysis on Subsequent of 25 Cases with Cervical Intraepithelial Neoplasia,Microinvasive Carcinoma after Cold-knife Conization

目的探讨CINⅢ和早期浸润癌冷刀锥切术后病变残存的病理因素。方法对首都医科大学附属北京天坛医院妇产科2001年10月至2007年10月间冷刀锥切术后行子宫切除术的25例CINⅢ和早期浸润癌标本进行病理分析,探讨冷刀锥切术后切缘状态、病变累及象限、累腺状态和间质微浸润与冷刀锥切术后宫颈病变残存的关系。结果冷刀锥切术后标本中无病变残存者17例(68%);有病变残存者8例(32%),其中,5例早期浸润癌患者术后均有病变残存但级别降低,3例CINⅢ患者术后有病变残存且降级。冷刀锥切术标本切缘状态、病变累及象限和累腺状态与术后宫颈病变残存间差异均无统计学意义(P>0.05)。患者病变中有累腺、多象限发生或间质微浸润者冷刀锥切术后容易有病变残存。结论术后诊断为早期浸润癌和CINⅢ者,应根据具体情况再治疗。

Objective To investigate the factors of residual lesions after cold-knife conization（CKC） with cervical intraepithelial neoplasia Ⅲ（CINⅢ）, microinvasive carcinoma. Methods 25 cases who had been treated by CKC due to CIN Ⅲ, microinvasive carcinoma underwent subsequent hysterectomy from October 2001 to December 2007. The pathologic study that carried out on conespecimens analysis the relationship between endocervical margin status, multiple-quadrant disease, glandular involvement, stroma microinvasive and residual disease in the post-cone hysterectomy specimens. Results 17 out of 25 cases（68% ） were diagnosed with no residual lesions after repeated operation. Eight cases （32%） had lesions lower than that of conization. All of five cases with microinvasive carcinoma had degraded residual disease. Three of 20 cases with CIN m had degraded residual lesions. No significant difference existed between endocervical margin status, glandular involvement, multiple-quadrant disease and residual disease in the post-cone hysterectomy specimens （ P 〉 0.05 ）. Patients with the presence of any two or more of the risk factors mentioned above, especially stroma microinvasive, should be considered as a high-risk group for having disease persistence after conization. Conclusion Patients with mieroinvasive carcinoma or CIN Ⅲ after conization could be given further individual treatment.