HSIL宫颈冷刀锥切术后切缘阳性的临床处理及转归

Treatment and Outcome of Residual Lesions after Cold Knife Conization of Cervical High-grade Squamous Intraepithelial Lesions

目的探讨宫颈高级别鳞状上皮内病变(HSIL)患者宫颈冷刀锥切术后切缘阳性的临床处理措施对疾病转归的影响及病变残留的高危因素。方法收集笔者医院2013年1月~2018年1月5年内因HSIL行宫颈冷刀锥切术后切缘阳性患者的临床资料及术后处理措施。后续临床处理分为3组,即再次锥切组(术后3个月再次施术)、子宫全切组(术后1周内施术)和随访组。每4~6个月行定期检查,包括人乳头瘤病毒(human papilloma virus,HPV)及宫颈细胞学(thinprep cytology test,TCT)检查,阴道镜检查,必要时宫颈活检或加做宫颈管搔刮。结果5年内笔者医院因HSIL行宫颈冷刀锥切术患者共1764例,其中切缘阳性286例,占16.2%。其中切缘为HSIL的241例(84.3%),切缘为浸润癌的45例(15.7%)。切缘阳性及Ⅲ型转化区是锥切术后病灶残留的危险因素。286例切缘阳性的患者随访最短30个月,最长90个月,子宫全切组与再次锥切组、随访组术后复发率比较,差异无统计学意义。结论宫颈锥切术后切缘阳性再次手术后病灶残留率低,再次手术的患者短期、长期复发结局无明显差别。因此,对于HSIL宫颈冷刀锥切术后切缘阳性的患者决定是否需要再次手术时应根据病理类型、年龄、有无生育要求等因素谨慎决策。

Objective To analyze the risk factors and treatments of residual lesions after conization of cervical high-grade squamous intraepithelial lesions. Methods The clinical data of patients after conization of cervix due to cervical high-grade squamous intraepithelial lesions in the Second Affiliated Hospital of Zhengzhou University from January 2013 to January 2018 was collected. The diagnosis of residual disease and recurrence were established and confirmed by biopsy. The follow-up clinical treatment is divided into 3 groups: cervical conization group(3 monthes after surgery).Hysterectomy(within 1 week after surgery). Follow-up group: TCT and HPV are performed every 4 months to 6 months, colposcopy biopsy and cervical canal curettage are performed if necessary. ResultsA total of 1764 patients underwent cold knife conization of the cervix due to HSIL in our hospital within 5 years, of which 286 had positive margins, accounting for 16.2%. Among them, 241 cases(84.3%) had HSIL at the resection margin;45 cases(15.7%) had invasive carcinoma at the resection margin. Positive margins and type Ⅲ transformation zone were the risk factors for residual lesions after conization. The shortest follow-up of 286 patients with positive margins was 30 months and the longest was 90 months. There was no significant difference in the recurrence rate between the hysterectomy group and the reconization group and the simple follow-up group. ConclusionAfter cervical conization with positive margins, hysterectomy does not improve the short-term and long-term recurrence outcome of patients. For HSIL patients with positive margins after cold knife conization, the decision to re-operate should be carefully selected according to the patient′s pathological type, age, whether there are fertility requirements and other factors.