宫颈管内镜下宫颈锥切术治疗高级别宫颈上皮内瘤变的效果分析

Analysis of the effect of cervical conization through cervical endoscopy in the treatment of Highgrade cervical intraepithelial neoplasia

目的探讨宫颈管内镜下宫颈锥切术应用于高级别宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)的临床效果。方法选取2017年6月至2019年6月哈尔滨市第一医院收治的CINⅡ、Ⅲ级患者100例,采用随机数字表法将患者分为对照组与观察组,每组各50例。对照组采用传统的宫颈冷刀锥切术,观察组采用宫颈管内镜下宫颈锥切术。比较两种手术方式的治疗效果。结果观察组的标本切缘阳性率明显低于对照组[8%(4/50)与18%(9/50)],两组比较差异有统计学意义(χ^2=4.98,P<0.05)。随访1年,观察组的治愈率高于对照组[96%(48/50)与84%(40/50)],残留率和复发率均低于对照组[6%(3/50)与14%(7/50),2%(1/50)与8%(4/50)],差异均有统计学意义(χ^2值分别为10.56、3.98、13.96,P均<0.05)。观察组的术后并发症发生率明显低于对照组[6%(3/50)与18%(9/50)],差异有统计学意义(χ^2=11.25,P<0.05)。而两组患者术中出血量、手术时间、伤口愈合时间比较差异均无统计学意义(t值分别为1.46、1.26、0.98,P均>0.05)。结论宫颈管内镜下宫颈锥切术治疗高级别CIN,可准确定位病灶,切除有效率高,复发率低,手术并发症少。

Objective To investigate the clinical effect of cervical conization under cervical endoscopy in high-grade cervical intraepithelial neoplasia(CIN).Methods From June 2017 to June 2019,100 patients with grade II and III CIN admitted to Harbin First Hospital were divided into control group and observation group with 50 cases in each group by random number table method.The control group was treated with traditional cervical cold knife conization,while the observation group was treated with cervical conization under endoscopy.To compare the therapeutic effects of two surgical methods.Results The incidence of positive margin were significantly lower than that in the control group(8%(4/50)and 18%(9/50)),and the difference was statistically significant(χ^2=4.98,P<0.05).The postoperative follow up was proceed one year.The incidence of cure were significantly higher than that in the control group(96%(48/50)vs.84%(40/50)),and the residual rate and recurrence rate were lower than that of the control group(6%(3/50)and 14%(7/50),2%(1/50)and 8%(4/50)),the difference was statistically significant(χ^2=10.56,3.98,13.96,all P<0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group[6%(3/50)and 18%(9/50)],the difference was statistically significant(χ^2=11.25,P<0.05).There was no significant difference in bleeding volume,operation time and wound healing time between the two groups(t value was 1.46,1.26 and 0.98 respectively,all P>0.05).Conclusion The cervical conization through cervical canal endoscope can accurately locate the focus of high-grade CIN,with higher rate of lesion clearance,lower rate of lesion recurrence and complications.