宫颈冷刀锥切术后宫颈癌56例临床诊疗分析

Clinical analysis of 56 patients with cervical cancer after cold knife conization

目的探讨宫颈冷刀锥切术对宫颈癌的诊断价值及锥切术后宫颈癌患者的进一步治疗。方法回顾性分析2008至2012年于北京大学人民医院行宫颈锥切术后诊断宫颈癌的患者56例的临床诊疗情况，并与阴道镜下进行活体组织检查病理学比较。结果（1）56例锥切术后确诊的官颈癌中，Ⅰa1期39例，Ⅰa2期2例，Ⅰb1期15例。与术前阴道镜活体组织检查病理学诊断比较，诊断不一致46例（82．1％）；（2）39例Ⅰa1期宫颈癌患者中，23例接受了再次手术，术后病理组织学检查提示宫颈仍然有病灶残余12例（52．2％），残余病灶分别为CIN15例、CINⅡ3例、CINⅢ3例；16例未行再次手术患者，随访未发现异常；（3）Ia2期、Ib1期患者均行2次手术，8例予术前化疗，其中Ⅰa2期1例，Ⅰb1期7例。结论宫颈锥切术在宫颈病变的诊断和治疗中具有重要价值，锥切后诊断宫颈癌的临床处理，应根据患者年龄、病变程度、切缘状态、生育要求等制定个体化、综合考虑以决定进一步的治疗方案。

Objective To evaluate the clinical value of conization in the diagnosis of cervical cancer to optimize its management. Methods Fifty-six patients diagnosed with cervical cancer after conization at our hospital between 2008 and 2012 were reviewed. The pathological profiles of eolposcopie multiple biopsies and treatment options were analyzed. Results Among them, there were stage I al （ n = 39 ）, stage I a2 （n = 2） and stage I bl （n = 15）. And there was not much correspondence between cervical conization and colposcopic multiple biopsies in 46 cases. Among 23 patients with stage I al undergoing further surgery, 12 （52. 17% ） had residual diseases, including CIN I （ n = 5 ）, CIN II （ n = 3 ）, CIN III （ n = 3 ）. No recurrence was found in 16 cases without further surgical intervention. All cases of stages I a2 and I bl underwent repeat surgery while 8 cases received preoperative chemotherapy, including stage I a2 （ n = 1 ） and stage I b2 （ n = 7 ）. Conclusion Cold knife conization plays a very important role in the diagnosis and treatment of cervical diseases. Further treatment options should be selected individually and comprehensively based on such factors as patient age, degrees of dysplasia, surgical margin status, fertility requirements and so on.