宫颈冷刀锥切术在CINⅢ患者中的诊断和治疗效果分析

Diagnosis and treatment of cervical cold-knife conectomy in patients with CINⅢ

目的分析宫颈冷刀锥切术在宫颈上皮内瘤变(CIN)Ⅲ患者中的诊断和治疗效果。方法抽取15例行宫颈冷刀锥切术的CINⅢ患者,对比宫颈冷刀锥切术病理检查结果与阴道镜活检结果、病理级别与阴道镜下多点活检病理级别、术后并发症发生率、随访结果。结果宫颈冷刀锥切术病理检查结果为CINⅠ为2例,CINⅡ为1例,CINⅢ为0例,原位癌、浸润癌均为0例。其中13例宫颈冷刀锥切术病理检查结果与阴道镜下多点活检结果一致,相符率为86.67%。宫颈冷刀锥切术病理级别与阴道镜下活检病理级别比较,差异有统计学意义(P<0.05)。患者平均术中出血量(38.56±3.96)ml,平均手术时间(40.01±3.96)min,住院时间(8.25±2.41)d。其中1例患者出现下腹部疼痛情况,1例出现少量阴道出血情况,1例创面活动性出血情况。术后并发症发生率占比为20.00%(3/15)。对全部出现并发症情况的患者,对症处理后患者各项指标恢复正常。术后对患者随访6个月,除宫颈浸润癌患者以外,其余患者宫颈外形恢复正常形态。结论在CINⅢ患者中的诊断和治疗中,宫颈冷刀锥切术的临床应用价值较高,阴道镜下多点活检无法取代,术后应当进行病理观察,还需要进行更密切的随诊,有助于达到良好的预后效果,具有较高的临床应用与推广价值。

Objective To analyze the diagnosis and treatment effect of cervical cold-knife coning in patients with CINⅢ(cervical intraepithelial neoplasia).Methods A total of 15 patients with CINⅢwho underwent cold-knife conical resection of cervix were selected,and the pathological examination results of cold-knife conical resection of cervix were compared with the results of colposcope biopsy,pathological grade and colposcope multi-point biopsy,postoperative complication rate and follow-up results.ResultsThe pathological results of cold knife conectomy of cervix showed that there were 2 cases of CINⅠ,1 case of CINⅡ,O case of CINⅢ,and O case of carcinoma in situ and invasive carcinoma.The pathological results of 13 cases were consistent with those of colposcopic multipoint biopsy,the coincidence rate was 86.67%.There were significant differences between the pathological grade of cervical cold-knife conectomy and colposcopic biopsy(P<0.05).The mean intraoperative blood loss was(38.56±3.96)ml,the mean operative time was(40.01±3.96)min,and the length of hospital stay was(8.25±2.41)d.Among them,1 patient had lower abdominal pain,1 patient had a small amount of vaginal bleeding,and 1 patient had active bleeding on the wound.The incidence of postoperative complications was 20.00%(3/15).For all the patients with complications,the indicators of the patients returned to normal after symptomatic treatment.The patients were followed up for 6 months after operation,except for the patients with cervical invasive cancer,the cervical appearance of the other patients returned to normal shape.Conclusion In the diagnosis and treatment of patients with CINⅢ,the clinical application value of cold-knife conical excision of the cervix is relatively high,and multi-point biopsy under colposcope cannot be replaced.Postoperative pathological observation should be carried out,and closer follow-up is also needed,which is conducive to achieving good prognostic effect,and has high clinical application and promotion value.