子宫颈微小浸润癌31例诊治分析

Diagnosis and management of 31 cases of micro-invasive carcinoma of cervix

目的分析子宫颈微小浸润癌(MIC)的临床特点,探讨采用子宫颈锥形切除术(宫颈锥切)治疗的可行性。方法分析2005年11月至2007年10月在北京协和医院经宫颈锥切确诊为MIC31例患者的临床表现、锥切病理、后续处理及预后。结果31例MIC患者中,24例有宫颈细胞学结果。所有患者均有阴道镜活检结果,其中1例(3.2%)子宫颈上皮内瘤变2级(CINⅡ),17例(54.8%)为宫颈上皮内瘤变3级(CINⅢ),13例(41.9%)怀疑早期浸润癌。根据锥切病理,23例被确诊为Ⅰa1期宫颈浸润癌(Ⅰa1期宫颈癌组),8例为Ⅰa2期宫颈浸润癌(Ⅰa2期宫颈癌组)。Ⅰa1期宫颈癌组中,3例(13.0%)有生育要求且切缘阴性的患者宫颈锥切术后接受严密随诊,1例(4.3%)切缘阳性但有生育要求的患者进行了再次锥切,其余19例(82.6%)无生育要求的妇女接受了全子宫(或加双附件)切除。Ⅰa2期宫颈癌组的8例患者全部进行了根治性子宫切除。随诊中除1例保留子宫的患者细胞学提示异常、经阴道镜宫颈活检诊断为CINⅢ外,其余患者未见病变复发。保留子宫的4例随诊期间共发生3例次妊娠。结论阴道镜活检对于MIC的诊断有重要提示价值,但MIC的确诊必须通过宫颈锥切病理。MIC的锥切后处理主要基于锥切病理,同时需要考虑患者的生育要求和切缘状况。

Objective To analyze the clinical characteristics and treatment of micro-invasive carcinoma of cervix （MIC） , to investigate the value of cervical conization in the management of MIC. Methods The clinical and pathologieal data of 31 patients with MIC diagnosed with cervical conization in Peking Union Medieal College Hospital between Nov.2005 and Oct. 2007 were retrospectively analyzed. Results Of 31 patients with MIC, 24 patients had cervical cytology results. Colpseopy-directed cervical biopsy was pertormed in all patients, which showed that 1 case （3.2%）was cervieal intraepithelial neoplasia （CIN） grade 2, 17 eases （54. 8% ） were CINⅢ, and 13 eases（41.9% ） were suspected as early invasive carcinoma, Based on pathological examination of eonization sample, 23 patients were＂ diagnosed as Ial cervical caneer （ Ⅰa1 group） and 8 patients diagnosed as Ⅰa2 cervical cancer （ Ⅰa2 group）. In Ⅰa1 group, 3 patients （ 13.0% ） with further childhearing desire and with negative eonization margin received close follow-up, 1 patient （4. 3% ） with further childbearing desire but with positive conization margin received repeat conization, while the other 19 patients （82.6%） without futher childbearing desire received hystercectomy （ or plus bilateral sampingo-oophoreclomy ）. All 8 patients in Ⅰa2 group were treated with radical hysterectomy. No disease recurrence oeeurred during follow-up, except one patient with uterus sparing who was found to be abnormal cervical cytology and confirmed as CINⅢ in subsequent colposcopie directed cervical biopsy. Three eases of pregnancies occurred in 4 patients whose uterus were not removed. Conclusion Colpscopy-directed cervical biopsy has important suggestive valve for patients with MIC, but the final diagnosis of MIC must only be based on eonization. Post-conization treatment of MIC depends mainly on the severity of cervical lesion, while patient＇s desire for childbearing and conization margin status should also be taken into consideration.