宫颈冷刀锥切术在诊断CINIII及早期宫颈癌中的价值

Value of Cervical Cold Knife Conization in Diagnosis of Cervical Intraepithelial Neoplasia Ⅲ( CINⅢ) and Early Cervical Cancer

目的对比观察阴道镜多点活检和宫颈冷刀锥切术两种方法对宫颈上皮内瘤样病变III级（CINIII）和宫颈癌的诊断价值。方法回顾性分析2014年1月至2014年12月我院妇瘤科收治的CINIII和可疑早侵癌患者233例,所有患者阴道镜下多点活检诊断为CINIII和可疑早侵癌并同时接受宫颈冷刀锥切术以进一步明确诊断,对比观察两种方法的诊断结果,总结宫颈冷刀锥切术的主要并发症。结果术前诊断CINIII的患者中宫颈冷刀锥切术后病理结果与阴道镜活检诊断结果完全符合140例（70.7%）;不符合者58例（29.3%）,其中病理降级38例（19.2%）,病理升级20例（10.1%）;术前阴道镜诊断可疑早侵癌的患者中,宫颈锥切术后病理结果与阴道镜完全符合31例（88.6%）,不符合者4例（11.4%）。所有患者均顺利完成宫颈冷刀锥切术,术中出血15-400 mL,其中大部分为50 mL以下出血;宫颈冷刀锥切术主要并发症为术后出血和宫颈管粘连。结论阴道镜多点活检诊断CIN和宫颈癌存在一定的漏诊和误诊,宫颈锥切术可以很好的弥补,在早期宫颈癌的诊断中具有重要的价值。

Objective To compare the value of colposcopic multi- point biopsy and cervical cold knife conization in diagnosis of cervical intraepithelial neoplasia Ⅲ（ CINⅢ） and early cervical cancer. Methods 233 cases with CINⅢ and suspected early invasion in cervical carcinoma received in Gynecological Oncology Department of our hospital from January 2014 to December 2014 were retrospectively analyzed. In those cases,all the patients were diagnosed with CINⅢ and suspected early invasion in cervical carcinoma by colposcopic multi- point biopsy,and a further diagnosis was made by cervical cold knife conization. Through the comparison of the diagnosis results of the two methods,the main complications of cervical cold knife conization were summarized. Results 140 cases（ 70. 7%） were diagnosed with the same result by the two methods among the patients diagnosed with CINIII before surgery,and 58 cases（ 29. 3%） were not. 38 cases（ 19. 2%） were downstaged and 20 cases（ 10. 1%） were upstaged among those cases. 31 cases（ 88. 6%） were diagnosed with the same result with the two methods among the patients diagnosed with suspected early invasion in cervical cancer before surgery,and 4 cases（ 11. 4%） were not. Cervical cold knife conization performed successfully on all the patients,with intraoperative blood loss 15 to 400 mL,most of which were under 50 mL. The main complications of cervical cold knife conization were postoperative hemorrhage and cervical cone tube adhesion. Conclusion Missed diagnosis and misdiagnosis happen in diagnosis of CIN and cervical cancer with colposcopic multi- point biopsy,while cervical cold knife conization can fix this situation,which is of great value in diagnosis of early cervical cancer.