改良式宫颈切除术治疗绝经后宫颈极度萎缩宫颈上皮内病变疗效观察

Efficacy of modified cervicectomy in treatment of intraepithelial lesions in women with severe postmenopausal cervical atrophy

目的 观察改良式宫颈切除术治疗绝经后宫颈极度萎缩宫颈上皮内病变的临床效果。方法 选取2017年6月至2021年8月浙江省立同德医院妇科收治的绝经后宫颈上皮内病变患者80例,因宫颈极度萎缩、手术困难而采用改良式宫颈切除术。观察患者围术期情况、术前及术后病理符合情况、二次手术情况及术后随访情况。结果 80例患者中55例宫颈直径为1~1.5 cm,采用宫颈锥切术及改良式2针法缝合宫颈;另25例宫颈直径<1 cm,采用宫颈截除术及改良式4针法缝合宫颈。宫颈锥切术患者、宫颈截除术患者手术时间分别为(33.93±9.36)、(38.20±9.56)min;术中出血量分别为(7.40±3.74)、(6.56±3.69)ml,术后住院时间(3.53±1.07)、(3.44±0.87)d,术后阴道出血时间分别为(11.67±3.34)、(11.52±3.28)d。宫颈锥切术患者、宫颈截除术患者手术时间、术中出血量、术后住院时间、术后阴道出血时间比较差异均无统计学意义(均P>0.05)。患者术中无一例发生周围脏器损伤,术中及术后无一例发生大量出血。术后仅2例行进一步手术,其中1例术后病理提示宫颈部分内口切缘阳性,1例术后病理升级为宫颈浸润癌。术后随访患者宫颈创面均愈合良好,宫颈外观重塑好,无一例继发宫颈肉芽组织增生等问题。结论改良式宫颈切除术在传统宫颈锥切及缝合方法上进行了改良,对于绝经后宫颈极度萎缩、手术困难的宫颈上皮内病变患者是较为安全、有效的手术方式。

Objective To observe the clinical efficacy of modified cervical resection in the treatment of intraepithelial lesions in women with severe postmenopausal cervical atrophy. Methods Eighty patients with postmenopausal cervical intraepithelial lesions received modification cervicectomy due to severe atrophy of the cervix in the Department of Gynecology of Tongde Hospital of Zhejiang Province from June 2017 to August 2021. The perioperative conditions, consistence of preoperative diagnosis and postoperative pathology, second operation and postoperative follow-up were documented.Results Among the 80 patients, 55 patients with cervical diameter of 1-1.5 cm were sutured by cervical conectomy and modified two-needle method, another 25 patients with cervical diameter less than 1cm were treated with cervical amputation and modified four-needle suture. The operation time of patients with cervical conectomy and patients with cervical amputation was(33.93±9.36) min and(38.20±9.56) min, the intraoperative blood loss was respectively(7.40±3.74) ml and(6.56±3.69) ml, the postoperative hospital stay was(3.53±1.07) d and(3.44±0.87) d, the postoperative vaginal bleeding(11.67±3.34) d and(11.52±3.28) d, respectively(all P>0.05). No injury of peripheral organs occurred during operation, and no massive bleeding occurred during and after operation. Only two cases underwent further surgery. One case was pathologically positive for cervical incision margin, and the other case was pathologically upgraded to cervical invasive carcinoma. Postoperative followup showed that the cervical wounds all healed well, the cervix had been remodeled, and there were no secondary cervical granulation tissue hyperplasia and other problems in all patients. Conclusion The modified cervical resection is an improvement on the traditional method of cervical coning and suturing. It is a relatively safe and effective surgical method for postmenopausal patients with severe cervicovaginal atrophy and cervical lesions.