两种不同锥切术在CINⅡ～Ⅲ患者中的疗效比较

Comparison of the efficacy of cervical cold knife conization and transcervica resection of cervical lesion in patients with CIN Ⅱ-Ⅲ

目的探究宫颈冷刀锥切术(CKC)和宫腔镜下宫颈锥切术(TCRC)对于宫颈上皮内瘤变(CIN)Ⅱ、CINⅢ的临床疗效。方法回顾性分析2014年1月至2017年7月东阳市妇幼保健院收治的429例CINⅡ~Ⅲ患者,其中190例行CKC患者为CKC组,239例行TCRC患者为TCRC组。比较两组患者围手术期情况、术前术后病理结果、术后并发症发生及随访情况。结果两组患者临床疗效比较无显著性差异(χ~2=1.176,P>0.05)。TCRC组围手术期出血量显著多于CKC组(t=3.246,P<0.05),而住院时间显著少于CKC组(t=2.119,P<0.05)。两组手术时间和住院花费无显著性差异(t值分别为1.093、0.990,均P>0.05),术前术后病理结果一致率无显著性差异(χ~2=0.416,P>0.05)。两组患者术后并发症发生率比较无显著性差异(χ~2=0.009,P>0.05)。随访12个月后,CKC组患者复发8例,复发率为4.21%;TCRC组患者复发9例,复发率为3.77%,两组患者术后复发率无显著性差异(χ~2=0.237,P=0.626)。结论 CKC与TCRC应用于CINⅡ~Ⅲ患者的治疗中疗效相当,TCRC能减少患者的住院时间,但术中患者出血量较CKC组患者多。

Objective To explore the clinical effect of cervical cold knife conization（CKC）and transcervica resection of cervical lesion（TCRC）on cervical intraepithelial neoplasia（CIN）Ⅱ and Ⅲ.Methods Retrospective analysis was conducted on 429 patients with CIN Ⅱ-Ⅲ admitted to Maternal and Child Health Hospital of Dongyang City from January 2014 to July 2017,including 190 cases receiving CKC grouped in CKC group and 239 cases receiving TCRC grouped in TCRC group.The perioperative situations,preoperative and postoperative pathological results,postoperative complications and follow-up were observed and compared between two groups.Results There was no significant difference in clinical efficacy between two groups（χ~2=1.176,P0.05）.The perioperative blood loss of TCRC group was significantly more than that of CKC group（t=3.246,P0.05）,while the length of hospital stay was significantly lower（t=2.119,P0.05）.There were no significant differences in surgical duration and hospital expenses between two groups（t value was 1.093 and 0.990,respectively,both P0.05）.There was no significant difference in the consensus rate of pathological results before and after surgery（χ~2=0.416,P0.05）.There was no significant difference in the incidence of postoperative complications betwee two groups（χ~2=0.009,P0.05）.After 12 months of follow-up,there were 8 cases of recurrence in CKC group with recurrence rate of 4.21%.In TCRC group,there were 9 cases of recurrence with recurrence rate of 3.77%.There was no significant difference in postoperative recurrence rate between two groups（χ~2=0.237,P=0.626）.Conclusion The effect of CKC and TCRC used in CIN Ⅱ-Ⅲ treatment is similar.TCRC can reduce patient＇s hospitalization time,but patients have more blood loss than patients receiving CKC.