宫颈冷刀锥切术诊治宫颈上皮内瘤变Ⅲ级320例临床分析

Clinical analysis of cervical cold knife conization for the diagnosis and treatment of 320 patients with cervical intraepithelial neoplasia

目的:探讨宫颈锥切术在宫颈上皮内瘤变Ⅲ级(CINⅢ)的诊断与治疗中的价值。方法:回顾性分析因宫颈CINⅢ行宫颈锥切术的患者320例,采用自身对照法,对比研究宫颈锥切术和阴道镜下活检的病理结果。结果:宫颈锥切术与阴道镜下检查的病理结果完全符合者187例(58.44%),不符合者133例(41.56%)。锥切术后病理诊断级别下降者69例(21.56%),漏诊微小浸润癌60例(Ⅰa1期55例,Ⅰa2期5例)(18.75%),漏诊浸润癌(Ⅰb1期)4例(1.25%)。59例患者再次行子宫切除术,其中32例(54.24%)术后病理转阴,16例病理诊断级别降低。宫颈锥切术的主要并发症是术后出血。结论:宫颈锥切术在CINⅢ的诊断和治疗中具有重要价值。应根据患者年龄、病变程度、切缘状态、生育要求等多方面个体化、综合考虑以决定进一步的治疗方案。

Objective：To evaluate the clinical value of cervical cold knife conization in diagnosis and management of cervical intraepithelial neoplasia.Methods：Three hundred and twenty patients with cervical intraepithelial neoplasia Ⅲ（CINⅢ） diagnosed and treated in Tianjin Central Hospital of Obstetrics and Gynecology were reviewed retrospectively focusing on the comparative study in pathology among cervical conization and colposcopic multiple biopsies and endocervical curettage（ECC）.Results：Of the 320 patients,there was a correlation in pathology between cervical conization and colposcopic multiple biopsies in 187 cases（58.44%）,but there was not much correspondence between cervical conization and colposcopic multiple biopsies in 133 cases（41.56%）.The pathological grade after cervical conization decreased in 69 cases（21.56%）.60 cases（18.75%）were diagnosed as microinvasive cervical cancer,containing 55 cases of stage Ⅰa1 and 5 cases of stage Ⅰa2,and 4 cases（1.25%） were diagnosed as invasive cervical cancer stage Ⅰb1.59 cases underwent hysterectomy.The pathology of subsequent hysterectomy became negative in 32 cases（54.24%） and downgraded in 16 cases.Postoperative hemorrhage was the main side effect for conization.Conclusion：Cervical cold knife conization plays a very important role in diagnosis and treatment of CIN Ⅲ.Further treatment options should be decided individually and comprehensively based on factors like patient＇s age,degree of dysplasia,surgical margin status,fertility requirements,and so on.