宫颈冷刀锥切术诊治宫颈上皮内瘤变262例及切缘阳性38例随访预后分析

Clinical analysis of Follow up and Prognosis of Cold Knife Conization for the Diagnosis and Treatment of 262 Patients with Cervical Intraepithelial Neoplasia and 38 Patients with Positive Incisal Margin

【目的】探讨宫颈冷刀锥切术（CKC）在宫颈上皮内瘤变（CIN）诊治中的价值及CIN手术切缘阳性患者的预后。【方法】对2006年6月至2009年6月262例在北京大学第三医院CINⅡ／Ⅲ患者行CKC的手术病理进行回顾性分析，并对38例手术切缘阳性术后随访资料进一步分析。【结果】①CKC术后与术前阴道镜活检病理级别对照46．60％（122／262）完全一致，41．9％（110／262）降级，11．5％（30／262）升级，发现早期浸润癌11例，浸润癌3例。49例进一步行全子宫切除术，8例行广泛子宫切除术，术后病理浸润癌1例，早期浸润癌3例，无1例病理升级。②CKc术后手术切缘阳性患者38例，20例选择保留子宫随访，13例本研究随访期间细胞学及HPV检测正常，3例阴道镜活检可见CINⅡ～Ⅲ行全子宫切除（2例为术后1年，1例为术后3年），4例失访；18例切缘阳性选择切除子宫，术后随访15例正常，1例术后一年为V1NⅠ，2例失访。【结论】CKC是宫颈病变诊断的一种简单易行、可靠的方法，对年轻有生育要求及强烈保留子宫愿望CKC手术切缘阳性也可选择保守治疗及严密随访。

[Objective]To evaluate the value of cold knife conization（CKC） in diagnosis and treatment of cervical intraepithelial neoplasia（C1N） and the prognosis of CIN patients with positive incisal margin. [Methods]The surgical pathology of 262 patients with CIN Ⅱ / Ⅲ who underwent CKC from June 2006 to June 2009 in the third hospital of Beijing University were analyzed retrospectively. The postoperative follow-up data of 38 cases with positive incisal margin were further analyzed. [Results]The consistency rate in pathological diagnosis between colposcopy biopsy and CKC was 46.60% （122/262）, and 11.5 % （30/262） of patients were found more severe after operation and 11.5 % （30/262） of patients were improved. Eleven cases were diagnosed as early invasive cervical cancer （CC）, and 3 cases were diagnosed as invasive cervical cancer（ICC）. Forty nine cases underwent hysterectomy and 8 cases underwent radical hysterectomy after CKC. One case was pathologically diagnosed as ICC and 3 cases were diagnosed as CC after operation. No one case was found more severe. The incisal margin was positive in 38 cases after CKC. Twenty cases retained uterus and were followed up. During follow up, the cytology and HPV of 13 cases were normal, and 3 cases were diagnosed as CIN Ⅱ - Ⅲ by colposcopy and underwent hysterectomy at 1 year and 3 years after operation, respectively. Four cases were not followed up. Eighteen cases with positive incisal margin underwent hysterectomy, and then became normal during follow up after operation. One case was diagnosed as CIN Ⅰ at 1 year after operation, and two cases were not followed up. [Conclusion]CKC is a simple and reliable method for the diagnosis of cervical lesion. The patients who are young and desire to retain the uterus even with positive incisal margine of CKC can choose conservative treatment and should be followed up closely.