子宫颈高级别上皮内病变冷刀锥切术后切缘阳性和全子宫切除术后病理结果比较

Comparsion of pathological differences between cervical high-grade intraepithelial lesions positive resection surgical margin after cold knife conization and hysterectomy

目的探讨子宫颈高级别上皮内病变(cervical high-grade intraepithelial lesions,CHGIL)锥切术后切缘阳性患者进一步的临床治疗方案。方法对74例CHGIL行子宫颈冷刀锥切切缘阳性,并同时行全切子宫的患者术后病理结果进行回顾性分析。结果子宫颈锥切切缘阳性与子宫病变残留有相关性(P<0.01);患者年龄、是否绝经及腺体是否受累与子宫病变的残留无明显相关性(p>0.05)。子宫颈管是否受累、病变累及象限与子宫病变残留率有显著相关性(P<0.01)。结论子宫颈冷刀锥切术和全子宫切除术是治疗CHGIL安全有效的治疗方法,但对于子宫颈冷刀锥切阳性患者,全子宫切除的选择必须慎重,部分可选择保守治疗或者再次锥切的方法 。

Purpose To compare the pathological ditter- ences between cervical high-grade intraepithelial lesions （CHGIL） positive resection surgical margin after cold knife conization and total hysterectomy, and to explore how to take further clinical treatment measures. Methods The pathologic results of 74 patients with CHGIL positive surgical margin after cold knife conization and hysterectomy were analyzed retrospec- tively. Results There was a correlation between positive cervi- cal incision margin and residual uterine lesion （ P 〈 0. 01 ）. Age, menopause status, gland involvement did not related to re-sidual uterine lesions（P 〉0. 05）. There was significant correla- tion between the lesion-related quadrant and the residual rate of uterine lesion （ P 〈 0. 01 ）. Conclusion Cold knife conization and hysterectomy are safe and effective treatments for CHGIL. However, for the positive resection surgical margin after cold knife conization cases, hysterectomy should be carefully chosen and may choose conservative treatment or re-cone cutting.