宫颈病变锥切术后病理切缘阳性患者的处理

Evaluation of the following treatment after cervical conization with positive margins for patients with cervical neoplasm

背景与目的:宫颈锥切术(包括LEEP刀)已广泛应用于宫颈疾病的诊治中,对锥切术后切缘阳性者如何处理是困扰临床医师的一个难题。本研究就宫颈锥切术后病理切缘阳性患者的处理方式进行探讨。方法:分析1998年—2008年528例宫颈锥切患者中,54例术后病理切缘阳性患者再治疗的临床资料。结果:将54例患者分成随诊组及治疗组,随诊组17例,治疗组37例。随诊组总的病变复发/持续/进展率为17.6%(3/17),治疗组为2.7%(1/37)。其中切缘CINⅠ-Ⅱ阳性者治疗组和随诊组均无复发;病理为CINⅢ的随诊组14例患者,1例病变持续存在,1例进展为宫颈鳞癌,治疗组20例均无复发;微小浸润癌切缘阳性治疗组10例中1例术后进展为鳞癌,其余9例术后随诊26个月无复发病例;浸润癌组随诊的患者中有1例复发为浸润性鳞癌,治疗组6例均无复发。结论:锥切病理为CINⅢ且切缘CINⅢ阳性患者应采取个体化治疗;锥切病理为微小浸润癌,切缘CINⅢ阳性可选择再次锥切或全子宫切除术;切缘微小浸润病灶阳性则应再次锥切或直接按照ⅠB1期处理;锥切病理为浸润癌患者应按浸润癌规范化治疗。

Background and purpose：Cervical conization, including high frequency loop electrosurgical excision procedure（LEEP） has been widely used in the treatment of cervical diseases, but how to deal with the patients with pathological positive margin is a problem for clinicians.The purpose of this study was to discuss the option of adjuvant treatment after cervical conization with positive margins for patients with cervical neoplasm.Methods：The data of 528 patients who had cervical conization from 1998 to 2008 was reviewed, among which 54 patients with pathological positive margin was retreated and analyzed.Results：Fifty-four patients were divided into observation group and treatment group, 17 cases were in observation group and 37 cases in treatmeat proup.The recurrence / duration / progress rate was 17.6%（3/17）, in treatment group it was 2.7%（1/37） in observation.CINⅠ-Ⅱ positive margins in both group had no recurrence;among 14 patients with CINⅢ, 1 lesion persisted, and 1 progressed to cervical squamous cell carcinoma, none in treatment group was recurrent;For those 10 patients with micro-invasive margin-positive cases, 1 progressed to squamous cell carcinoma, the remaining 9 cases were followed up for 26 months without recurrence after operation.One case in invasive cancer group had recurrence.Conclusion：The patients with CINⅢ margin-positive patients after conization should receive individualized treatment.The patient with microinvasive carcinoma should be retreated with either re-conization or hysterectomy;if with margin-positive CINⅢ after conization, or re-conization or directly treated according to guideline addressing for ⅠB, if margin showed microinvasive carcinoma.The patients with margin-positive invasive carcinoma after conization should be treated according to guideline.