宫颈锥切术在高级别宫颈上皮内瘤样病变诊治中的价值

Diagnosis and therapy value of cervical conization in high level cervical intraepithelial neoplasia

目的研究宫颈锥切术对经宫颈多点活检诊断为高级别宫颈上皮内瘤样病变(包括原位癌)作进一步诊断和治疗的价值。方法回顾性分析徐州市肿瘤医院妇科2000—2011年收治的经宫颈多点活检诊断的高级别宫颈上皮内瘤样病变(包括原位癌)的患者共99例。52例直接施行全子宫切除术(全子宫切除组),47例先行宫颈锥切术(宫颈锥切组),对切缘阳性无生育要求或虽切缘阴性仍坚决要求切除子宫的患者再施行全子宫切除术。对两组术后病理诊断为浸润癌的患者均补行广泛性全子宫切除加盆腔淋巴结清扫术。比较两组手术前后的病理诊断符合率、浸润癌的检出率及子宫切除术后的补充手术率。结果两组相比,术后诊断符合率无明显差异,对宫颈浸润癌的检出率差异无统计学意义(P>0.05)。结论宫颈锥切术对高级别宫颈上皮内瘤样病变具有治疗价值,还可以检出宫颈多点活检漏诊的浸润癌,弥补宫颈多点活检诊断的不足,是全子宫切除前排除宫颈浸润癌不可忽略的步骤。

Objective To investigate the diagnosis and therapy value of cervical conization in high level cervical intraepithelial neoplasia （including carcinoma in situ） . Methods 99 cases of high level cervical intraepithelial neoplasia were retrospective studied. All cases were diagnosed in Xuzhou cancer hospital from may 2000 to march 2011 by cervical multi-point cervix cutting biopsy. 52 cases directly received hysterectomy（ hysterectomy group） , the other 47 patients reeeived cervical eonization firstly（ cervix conization group） , execute all patients with hysterectomy who had the positive margins or those had barren requirements and insisted on the hysterectomy without positive margins. Infiltrating carcinoma cases of two groups received extensive hysterectomy and pelvic lymph node dissection. Results Two groups had pathologic diagnosis coincidence rate for cases of high level cervical intraepithelial neoplasia. The detection rate of infiltrating carcinoma by two methods had no significant difference （ P 〉 0.05）. Conclusions For cases of high level cervical intraepithelial neoplasia, cervical conization could diagnose infiltrating cervical cancer and reduce the chance of supplementary operation for those who insisted on hysterectomy. So it is necessary to execute cervix conization before hysterectomy for cases of high level cervical intraepithelial neoplasia.