210例CIN Ⅲ行LEEP及全子宫切除术后病理分析

Pathological analysis in 210 cases of CIN Ⅲ following LEEP and total hysterectomy

目的:探讨宫颈上皮内瘤变行宫颈环形电切术(LEEP)术后再行全子宫切除术的临床意义。方法:回顾我院210例因CINⅢ行全子宫切除术病例,分析LEEP与全子宫切除术后病理结果的关系。结果:术后全子宫病理示宫颈慢性炎59.05%(124/210),病灶残余率40.95%(86/210),其中宫颈癌Ⅰa 1期1.43%(3/210),CIN Ⅲ22.38%(47/210)、CIN Ⅱ10.48%(22/210)、CINⅠ6.67%(14/210);LEEP术后切缘阳性病灶残余率41.95%(73/174),切缘阴性病灶残余率36.11%(13/36);两组间差异无统计学意义(χ~2=0.4211,P>0.05)。结论:LEEP是治疗CIN Ⅲ的重要方法,对于无生育要求或已绝经患者,LEEP术后无论切缘是否累及均可行全子宫切除术,以减少发生宫颈癌风险,但所有患者均行全子宫切除可能存在过度治疗。

Objective： To evaluate the necessity of total hysterectomy in women with cervical intraepithelial neoplasia grade Ⅲ（ CIN Ⅲ） following loop electrosurgical excision procedure（ LEEP）.Methods： Retrospective analysis was performed in 210 cases of CIN Ⅲ received LEEP before total hysterectomy regarding the pathological findings.Results： Pathological examination of the postoperative full specimens indicated chronic cervical inflammation in 59.05%（ 124 /210） and residual lesion in 40.95%（ 86/210）,including cervical cancer at stage Ⅰa1 in 1.43%（ 3 /210）,CIN Ⅲ in 22.38%（ 47/210）,CINⅡ in10.48%（ 22 / 210） and CIN I in 6.67%（ 14 / 210）.Surgical margin following LEEP was positive in 41.95%（ 73 / 174）,and negative in 36.11%（ 13 / 36）.The difference was not significant（ χ2= 0.4211,P〉0.05）.Conclusion： LEEP is one of the important approaches to treatment of CIN Ⅲ,and total hysterectomy,regardless of positive margin following LEEP,is recommend for women free of fertility or of postmenopause.However,it is important to prevent excessive treatment by applying total hysterectomy in all patients following LEEP.