宫颈外切缘阳性的CINⅢ患者仅行宫颈锥切术的可行性及影响因素

The Feasibility and Influence Factors of Cervical Conization for CIN Ⅲ Patients with Positive Cervical Excision Margin

目的探讨宫颈外切缘阳性的CINⅢ患者仅行宫颈锥切术的可行性及影响因素。方法将148例宫颈外切缘阳性的CINⅢ患者分成保守组和非保守组两组,比较72例保守组与76例非保守组宫颈外切缘阳性患者的组织病理学结果,再将非保守组又分为LEEP组和CKC组,并对出血量、手术时间、术后出血量、浸润癌等术后病理指标进行比较。结果保守组与非保守组的复发率比较无统计学意义,LEEP组与CKC组的出血量、手术时间、术后出血量比较有统计学意义,绝经状态、病变范围、内切缘阳性、宫颈管受累、术前HPV载量与宫颈锥切术后残留病灶相关(P<0.05);年龄、腺体受累与宫颈锥切术后残留病灶无关(P>0.05)。结论宫颈外切缘阳性的CINⅢ患者仅行宫颈锥切术是可行的,并且CKC法较LEEP法更可靠,绝经状态、病变范围、内切缘阳性、宫颈管受累是手术的主要影响因素。

Objective To explore the feasibility and influence factors of cervical conization for CINⅢ patients with positive cervical excision margin. Methods 148 cases of CINⅢ patients with positive cervical excision margin were divided into the conservative group( n = 72) and non-conservative group( n = 76),histopathological results of the 2 group s were compared. The non-conservative group was divided into the LEEPgroup and CKC group,bleeding volume in surgery,operative time,postoperation bleeding,postoperative infiltrating carcinoma were compared. Results There had no significant difference in recurrence rate between the 2 group s,bleeding volume in surgery,operative time,postoperative bleeding between the LEEPgroup and CKC group had statistically significant difference,menopausal status,scope of lesions,positive cutting edge,cervical tube involvement,preoperative HPV loads were associated with cervical cone cutting postoperative residual lesions( P < 0. 005); Age,gland involvement were not associated with postoperative residual lesions of cervical conization( P > 0. 05). Conclusion Cervical conization for CINⅢ patients with positive cervical excision margin is feasible,and CKC method is more reliable compared with LEEP,menopausal status,scope of lesions,positive cutting edge,cervical involvement are the main influence factors of the operation.