宫颈冷刀锥切术在宫颈上皮内瘤变Ⅲ的诊治中的价值

Elvation of cold-knife conization in diagnosis and treatment of 105 cases with cervical intraepithelial Neoplasis Ⅲ

目的评估宫颈冷刀锥切术(cold knife conization,CKC)在宫颈上皮内瘤变Ⅲ(CINⅢ)诊疗中的临床价值。方法采用自身对照法,观察105例CINⅢ患者阴道镜下多点活检、宫颈锥切术的病理结果。结果 CKC与阴道镜下多点活检完全符合者79例(75.2%)。不符合者26例(24.8%),16例(15.2%)升级,均为早浸癌;10例降级(9.5%)为CINⅠ和CINⅡ;切缘未净4例(15.2%)。11例行筋膜外子宫切除术和扩大的子宫全切术,术后病理8例CINⅢ、2例宫颈鳞癌1A期、1例宫颈鳞癌1B期。所有病例术后随访,4例复发,宫颈细胞学检查3例CINⅠ、1例CINⅡ。宫颈锥切术后主要并发症为术后出血。结论宫颈锥切术可以提高CINⅢ的诊断准确率,预防浸润癌的漏诊,是CINⅢ应首选的治疗方法。

Objective To analyse the clinical valuation of cold- knife conization in diagnosis and treatment of cervical intraepithelial neoplasia Ⅲ （ CIN Ⅲ） . Methods Using self comparison, method to observe the pathological examination results of 105 cases with CIN Ⅲ, which received, colposcopic multiple points biopsy and cervical conization. Results 79 patients, pathological examination results of colposcopic multiple points biopsy and cervical conization were accordant, accounting for 75.2% ,26 patients, results were discordant, accounting for 24. 8%. 16 cases among of them were removed in pathological examination results ,which were all early invasive cancer. In contrast 10 cases were degraded, which were CIN Ⅰ and CIN Ⅱ. 11 cases were received hysterectomy or extended hysterectomy, among of them 8 cases, pathological examination results were CIN Ⅲ, 2 cases belonged to 1A stage and one belonged to 1B stage. There were 4 cases （3.8%） of cervical conization in patients with marginal involvement, 2 cases among of them underwent hysterectomy. All patients were followed up, 4 cases relapsed. The main postoperative complication were bleeding. Conclusion This results show that cecervical conization can develop the diagnoses veracity, so that prevent lossing patients who with CIN Ⅲ. It is the first way in in diagnoses and treatment of patients with CIN Ⅲ.