个体化量化宫颈锥切术治疗阴道镜检查不充分的子宫颈鳞状上皮内病变的疗效分析

Analysis of the curative effect of individualized quantitative cervical conization for cervical squamous intraepithelial lesion by insufficient colposcopy

目的 分析对阴道镜检查不充分的子宫颈鳞状上皮内病变(SIL)行个体化量化宫颈锥切术的疗效。方法 192例围绝经期及绝经后阴道镜检查不充分的SIL患者作为研究对象,术前均经B超测量宫颈管长度,然后行个体化量化宫颈锥切术,其中108例行子宫颈冷刀锥切术(CKC)作为CKC组,84例行子宫颈环形电切术(LEEP)作为LEEP组。对宫颈锥切术后病理为高级别鳞状上皮内病变(HSIL)的52例患者追加筋膜外全子宫切除术或宫颈补切术。分析宫颈锥切术后切缘阳性的单因素及HSIL追加筋膜外全子宫切除术或宫颈补切术后残留宫颈病理情况。结果 192例SIL患者行宫颈锥切术后切缘阳性35例,其中CKC组术后切缘阳性率为18.52%(20/108), LEEP组术后切缘阳性率为17.86%(15/84),两组术后切缘阳性率比较,差异无统计学意义(P>0.05)。单因素分析显示,切缘阳性患者病变累及腺体占比65.71%(23/35)高于切缘阴性患者的43.95%(69/157)(P<0.05);而切缘阳性患者与切缘阴性患者的手术方式、高危人类乳头瘤病毒(HPV)感染情况、细胞学、阴道镜病理级别比较差异无统计学意义(P>0.05)。对宫颈锥切术后病理为HSIL的52例患者追加手术, 42例有子宫切除的要求或指征,追加了筋膜外全子宫切除术,其中CKC组18例, LEEP组24例。其余10例据术后病理提示阳性部位追加宫颈补切术,其中CKC组7例, LEEP组3例。追加手术后CKC组及LEEP组残留宫颈阳性率比较差异无统计学意义(P>0.05)。结论 个体化量化的两种宫颈锥切手术治疗围绝经期及绝经后阴道镜检查不充分的SIL疗效无显著性差异,对有保留子宫要求的患者, LEEP也是切实可行的治疗方法。

Objective To analyze the curative effect of individualized quantitative cervical conization for cervical squamous intraepithelial lesion(SIL)by insufficient colposcopy.Methods 192 perimenopausal and postmenopausal women with SIL by insufficient colposcopy were involved in the study,whose length of cervical canals was all measured by B-mode ultrasound before operation.Then they were conducted with individualized quantitative cervical conization,including 108 cases of cold-knife conization(CKC)and served as the CKC group,and 84 cases of loop electrosurgical excision procedure(LEEP)and served as the LEEP group.52 patients whose pathology were diagnosed as high-grade squamous intraepithelial lesion(HSIL)were performed with extrafascial hysterectomy or additional hysterectomy.The single factor of positive margins after cervical conization and the residual cervical pathology after extrafascial hysterectomy or additional hysterectomy for HSIL were analyzed.Results 35 of 192 SIL patients had positive margins after cervical conization,of which the postoperative margin positivity rate of the CKC group was 18.52%(20/108),and that of the LEEP group was 17.86%(15/84).There was no significant difference in postoperative margin positivity rate between the two groups(P>0.05).Univariate analysis showed that the percentage of lesions involving glands was 65.71%(23/35)in margin-positive patients,which was higher than 43.95%(69/157)in margin-negative patients(P<0.05).There was no statistically significant difference in the comparison of surgical methods,high-risk human papillomavirus(HPV)infection,cytology,and colposcopic pathology grade between margin-positive patients and margin-negative patients(P>0.05).Additional surgeries were performed in 52 patients with pathology of HSIL after cervical conization,42 cases had the requirement or indication for hysterectomy and additional extrafascial hysterectomy was performed,including 18 cases in the CKC group and 24 cases in the LEEP group.In the remaining 10 cases,cervical conization was performed on positive sites according to postoperative pathology,including 7 cases in CKC group and 3 cases in LEEP group.There was no statistically significant difference in the residual cervical positivity rate between the CKC group and the LEEP group after additional surgery (P>0.05). Conclusion There is no significant difference in SIL efficacy between the two methods of individualized quantitative cervical conization to treat perimenopausal and postmenopausal women with SIL by insufficient colposcopy. Therefore, LEEP is a practical therapy for those who require to retain their uterine.