宫腔镜下宫颈锥切术和宫颈冷刀锥切术治疗绝经后女性宫颈上皮内瘤变2级临床对比研究

Clinical comparative study of transcervical resection of cervical lesion and cervical cold knife conization in treatment of cervical intraepithelial neoplasia 2in postmenopausal women

目的探讨宫腔镜下宫颈锥切术(TCRC)和宫颈冷刀锥切术(CKC),治疗绝经后女性宫颈上皮内瘤变(CIN)2级的术中及术后情况。方法选择2010年10月至2018年3月,于首都医科大学附属北京妇产医院进行治疗的60例绝经后CIN2级患者为研究对象。按照对CIN2级患者采用锥切治疗术式的不同,将其分为TCRC组(n=30,采用TCRC治疗)和CKC组(n=30,采用宫颈CKC治疗)。对2组患者一般临床资料、手术时间、术中出血量、术后住院时间、术后阴道出血、术后标本切缘阳性率、术后感染情况及手术前、后组织病理学诊断符合率等,采用成组t检验或χ2检验等统计学分析方法,进行回顾性临床对比研究。本研究遵循的程序,符合2013年修订的《世界医学协会赫尔辛基宣言》的要求。结果 (1) 2组绝经后CIN2级患者的年龄、绝经年龄、绝经时间、术前人乳头瘤病毒(HPV)阳性率及术前液基薄层细胞学检查(TCT)结果等一般临床资料比较,差异均无统计学意义(P>0.05)。(2) 2组绝经后CIN2级患者均顺利完成手术,术后均未发生局部或其他部位感染。TCRC组患者手术时间、术中出血量及术后住院时间分别为(20.7±9.6)min、(11.5±6.8)mL、(2.3±1.3)d,均短于或少于CKC组的(34.5±8.2)min、(36.0±18.7)mL、(4.1±1.4)d,并且差异均有统计学意义(t=5.981、6.731、5.133,P<0.001)。2组患者术后阴道出血率、标本切缘阳性率及手术前、后组织病理学诊断符合率比较,差异均无统计学意义(P>0.05)。结论 TCRC治疗绝经后CIN2级患者,较宫颈CKC具有术中出血量更少、手术时间更短、患者恢复更快等优点,是一种可视、微创、安全的治疗方法。

Objective To investigate the intraoperative and postoperative parameters of transcervical resection of cervical lesion(TCRC)and cervical cold knife conization(CKC)in treatment of cervical intraepithelial neoplasia(CIN)2 in postmenopausal women.Methods A total of 60 postmenopausal women with CIN2 who were hospitalized in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from October 2010 to March 2018,were chosen as research subjects.According to the received surgical method for CIN2 patients,they were divided into TCRC group(n=30,patients received TCRC)and CKC group(n=30,patients received cervical CKC).With the retrospective clinical comparative study,the general clinical data,operative duration,amount of intraoperative blood loss,hospitalization duration after operation,postoperative vaginal bleeding,postoperative cut edge positive rate of specimen,infection condition after operation,and coincidence rate of preoperative and postoperative pathological results were statistically compared between two groups of patients by independent-samples t test or chi-square test.The study met the requirements of World Medical Association Declaration of Helsinki revised in 2013.Results①There were no significant differences between two groups of postmenopausal patients with CIN2 in patients′age,menopausal age,menopausal time,preoperative human papilloma virus(HPV)positive rate and preoperative thinprep cytologic test(TCT)result(P>0.05).②The patients in two groups were operated successfully,and presented neither local infection nor systemic infection after operation.The operative duration,amount of intraoperative blood loss and hospitalization duration after operation in TCRC group were(20.7±9.6)min,(11.5±6.8)mL,(2.3±1.3)d,which were all shorter or less than those in CKC group,which were(34.5±8.2)min,(36.0±18.7)mL,(4.1±1.4)d,and the differences were statistically significant(t=5.981,6.731,5.133;P<0.001).There were no significant differences between two groups of patients in incidence rate of postoperative vaginal bleeding,the postoperative cut edge positive rate of specimen and the coincidence rate of preoperative and postoperative pathological results(P>0.05).Conclusions TCRC in the treatment of CIN2 in postmenopausal women has several advantages of less amount of intraoperative blood loss,shorter operative time and faster recovery of patients than cervical CKC.It is a visual,minimally invasive and safe treatment method.