宫颈锥切术中子宫颈鳞状上皮内高度病变累及范围及锥切高度的判断

Determination of excision depth in conization of cervical high.grade squamous intraepithelial lesion

目的 探讨如何判断子宫颈鳞状上皮内高度病变（HSIL）累及范围和锥切高度及其对宫颈锥切术的指导意义。 方法 回顾性分析2015年1—12月于首都医科大学附属 北京妇产医院妇科微创中心因HSIL行宫颈冷刀锥切术的62例患者的临床资料，根据术后实际测量的锥切标本锥高分为A组（8例，锥切高度≤1.5 cm）、B组（38例，1.5 cm＜锥切高 度≤2.0 cm组）、C组（16例，锥切高度＞2.0 cm）。分别统计各组的术后病理结果、内切缘阳性情况及镜下最高级别子宫颈鳞状上皮内病变累及子宫颈管的高度。 结果 62例 患者中，术后病理升级为早期浸润性鳞状细胞癌6例（9.7%），病理级别下降13例（21.0%），病理级别与术前相同43例（69.3%），组间比较差异均无统计学意义（均P＞0.05）。A 组子宫颈管内切缘阳性率明显高于B组、C组［25.0%（2/8）比10.5%（4/38）、6.3%（1/16），P＜0.05］。62例标本共检出268点HSIL，累及子宫颈管高度范围为0.4～2.3 cm，其 中99%的病变高度＜2.0 cm，95%的病变高度＜1.5 cm；3组最高级别病变累及子宫颈管高度组间比较差异无统计学意义（P＞0.05）。 结论 锥切高度达到1.5 cm时可切除95%的 宫颈病变，达到2.0 cm时可切除99%的病变；锥切高度小于1.5 cm时内切缘阳性率增高，影响治疗效果。

Objective To investigate how to derermine the optiminal excision depth in conization of cervical high-grade squamous intraepithelial lesion （HSIL）. Methods A total of 62 patients with cervical HSIL who had cold knife conization from January to December 2015 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University were enrolled. All patients were divided into 3 groups according to the height of excision specimen after operation： group A（8 cases, ≤1.5 cm）, group B（38 cases, 〉1.5 cm and ≤2.0 cm）, group C（16 cases, 〉2.0 cm）. Postoperative pathological examination results, inner margin positive rate and the height of the highest grade cervical squamous intraepithelial lesion were analyzed. Results In 62 cases of cervical HSIL, 6 cases（9.7%） were diagnosed of invasive squamous cell carcinoma according to postoperative pathological examination, 13 cases（21.0%） were diagnosed as lower grade squamous intraepithelial lesion, 43 cases（69.3%） had the same pathological results as before; there were no significant difference among groups（P〉0.05）. The inner margin positive rate in group A was significantly higher than that in group B and group C[25.0%（2/8） vs 10.5%（4/38）, 6.3%（1/16）]（P〈0.05）. Totally 268 samples of HSIL were detected in 62 cases; the height range was 0.4-2.3 cm; the height in 99% samples was less than 2.0 cm; the height in 95% samples was less than 1.5 cm; there were no significant differences among groups（P〉0.05）. Conclusion 95% cervical lesions can be removed when the excision depth is 1.5 cm in conization; 99% lesions can be removed when the excision depth is 2.0 cm; the inner margin positive rate increases when the excision depth is less than 1.5 cm.