子宫颈高级别上皮内瘤变患者锥切术后切缘阳性的处理及预后探讨

Discussion on the Treatment of Positive Margin for Patients with Cervical Intraepithelial Neoplasia after Conization and the Prognosis

目的探讨子宫颈高级别上皮内瘤变锥切术后切缘阳性的处理及预后,总结治疗经验。方法以子宫颈高级别上皮内瘤变患者锥切术后切缘阳性再行手术治疗的228例作为研究对象,根据第2次术后病理结果将研究对象分为病变残留和无残留两组,对两组患者相关因素进行比较分析。结果病变无残留者133例,占58.33%,残留者95例,占41.67%,两组患者年龄差异无统计学意义(P>0.05),首次手术方式、病变级别、阳性切缘病变级别、阳性切缘部位、HPV差异有统计学意义(P<0.05)。结论术前HPV高拷贝、病变级别高、特别是原位癌、阳性切缘位于颈管端的患者病变残留高风险,需行再次锥切或严密随访。切缘部位为原位癌者建议扩大子宫切除。具体治疗方案需结合患者意愿、生育要求、随访条件而定。

Objective To investigate the treatment of positive margin for patients with cervical intraepithelial neoplasia after conization and the prognosis, and summarize the experience of treatment. Methods 228 cases of cervical intraepithelial neoplasia patients with positive margin after conization underwent surgical treatment for the second time were selected as the subjects. Based on the second postoperative pathology results, the subjects were divided into two groups of residual lesions and no residue, and the related factors of two groups of patients were compared and analyzed. Results The lesions without residual in 133 cases, accounting for 58.33%, residual in 95 cases, accounting for 41.67%; the difference between two groups in age was not statistical-ly significant （P〉0.05）, but the differences between the groups in the first mode of operation, pathological grade, positive margin lesion grade, positive margin part, and HPV were statistically significant （P〈0.05）. Conclusion Preoperative HPV high copy, high grade lesions, especially carcinoma in situ, positive margins in the neck tube end of the lesions in patients with residual high risk, need the second conization or close follow-up. Expanding uterus excision is suggested for the patients whose cutting edge part is carcinoma in situ. The specific treatment should be combined with the patient＇s wish, fertility requirements and follow-up conditions.