宫颈冷刀锥切术和宫腔镜下宫颈锥切术治疗高级别宫颈上皮内瘤变的疗效分析

Clinical Efficacy of Cold Knife Conization and Transcervical Resection of Cervical Lesionin the Treatment of Cervical Intraepithelial Neoplasia Ⅱ,Ⅲ

目的:比较宫颈冷刀锥切术(CKC)和宫腔镜下宫颈锥切术(TCRC)对于宫颈上皮内瘤变(CIN)Ⅱ、Ⅲ的临床疗效。方法:选取2010年1月1日至2014年6月1日就诊于南方医科大学珠江医院,手术、病理及随访资料完整的CINⅡ、Ⅲ患者共176例,其中CKC组62例,TCRC组114例。比较两组患者年龄、孕产次数及术前病理分级并评估手术时间、术中出血量、术后阴道流血及病理切缘阳性和术后宫颈狭窄、复发等情况。结果:两组患者年龄、孕产次数及术前CIN分级差异均无统计学意义(P>0.05)。CKC组术中平均出血量(14.16±14.10 ml)、平均住院时间(5.73±1.43天)与TCRC组(29.80±20.55 ml,4.75±1.23天)比较差异有统计学意义(P<0.05)。CKC组平均手术时间(33.15±11.42分钟)、术后阴道流血率(33.9%)、病理切缘阳性率(3.2%)、宫颈狭窄率(4.8%)、复发率(4.8%)与TCRC组(分别为33.18±14.61分钟、21.1%、5.3%、4.4%、3.5%)比较差异无统计学意义(P>0.05)。CKC组术前宫颈活检病理和术后病理结果一致率为74.2%(46/62),TCRC组为72.8%(83/114),kappa值<0.75。结论:两种方法用于治疗高级别宫颈上皮内瘤变均安全有效。与CKC相比,TCRC可减少患者住院时间,但可能增加术中出血量,需在手术中注意。

Objective：To compare the clinical efficacy of cold knife conization and transcervical resection of cervical lesion in the treatment of cervical intraepithelial neoplasia（CIN） II,III. Methods： The clinical data of 62 patients with CIN II,IIIunderwent cold knife conization（CKC group） and 114 underwent transcervical resection of cervical lesion（TCRC group）in Zhujiang Hospital Southern Medical University from Jan 1 st 2010 to Jun 1 ,t 2014 were collected. The patients＇ age, pregnant frequency, mean operative time, preoperative pathological grading, blood loss during the operation and after the operation,positive resected margin,cervical stenosis and recurrencewere compared between the two groups. Results： There was no difference on the patients age, pregnant frequen- cy and preoperative pathological grading between the two groups（P〉0.05）. The mean blood loss during the op- eration （14. 16 ± 14. 10 ml ） and the mean hospital stays（5.73 ± 1.43 days）of CKC group were significantly differ- ent from those of TCRC group（29.80 ±20.55 ml,4.75 ±1.23 days） （P〈0.05）. There was no statistical differ- ence on the mean operation time, postoperative vaginal bleeding rate, rate of positive resected margin, cervical stenosis rate and recurrence rate between CKC group and TCRC group （33. 15± 11.42 min vs 33. 18 ± 14. 61 min,33.9% vs 21.1%, 3.2% vs 5.3%,4.8% vs 4.4%,4.8% vs 3. 5%, respectively ） （ P 〉 0.05）. The concordance rate of pre-operation and post operation pathological results of CKC group and TCRC group was 74.2% （46/62）and 72.8% （83/114 ）respectively, both kappa values were 〈 0.75. Conclusions： Both CKC and TCRCT are safe as well as effective in the treatment of high-grade cervical intraepithelial neoplasia. Compared with CKC,TCRC has the advantage of short hospital stay,while much intraoperative blood loss,which calls for in- traoperative attention.