冷刀宫颈锥切术在CIN Ⅲ诊治中应用价值探讨(附120例分析)

Exploration of the application value of cold knife conization in diagnosis and therapy of cervical intraepithelial neoplasia Ⅲ:Analysis of 120 cases

目的探讨冷刀宫颈锥形切除术(cold knife conization,CKC)在宫颈上皮内瘤变(cervical intraepithelialneoplasia,CIN)Ⅲ级诊治中应用价值。方法对我院收治的120例经多点活检病理证实为CINⅢ患者行CKC,观察手术情况及并发症,并比较术前、后病理结果差异。结果 (1)120例均顺利完成手术,手术成功率100%。手术平均时间及出血量分别为(50.8±24.3)min与(37.3±36.9)mL,手术并发症少且轻,主要为术后创面渗血,术后随访无复发病例。(2)锥切术前、后病理诊断相符67例(55.8%),术后病理升级为浸润癌33例(27.5%),降级为CINⅠ～Ⅱ20例(16.7%)。(3)33例浸润癌及37例无生育要求CINⅢ患者锥切术后再行子宫切除,分别有8例(24.2%)及3例(8.1%)残余宫颈中存在持续性病变。结论 CKC是诊治CINⅢ一种安全、合理的方法,兼具诊断性及治疗性双重作用,对于临床上CINⅢ病例,应首选CKC,根据术后病理决定最终的诊断及治疗方案。

Objective To investigate the application value of cold knife conization （CKC） ir/ diagnosis and treatment of cervical intraepithelial neoplasia Ⅲ （CIN Ⅲ ）. Methods One hundred and twenty cases of CIN Ⅲ patients diagnosed by multiple biopsies were underwent CKC, the surgical efficiency and complications were observed and the pathological difference between preoperative and postoperative was compared at the same time. Results The success rate of operation was 100K, the mean operation time and blood loss was （50.8±24.3） min and （37.3±36.9） mL respectively, the complication of CKC was quite low and mild and the major of which was incision hemorrhage, there was no recurrent cases in the follow-up. Among 120 cases, 67 cases （55.8 %） remained the same pathological results postoperative, while 33 cases （27.5 %） were confirmed as invasive carcinoma and 20 cases （16.7%） were confirmed as CIN Ⅰ-Ⅱ . Thirty-three cases because of invasive carcinoma and 37 cases CIN Ⅲ patients without further fertility performed hysterectomy after CKC, persistent lesion was found in eight cases （24.2 %） and three cases （8.1%） of the residual cervix respectively. Conclusion CKC is a safe and rational method in diagnosis and therapy of CIN Ill and which also the first choice for it.