论文部分内容阅读
背景与目的:高频电波刀电圈切除术和宫颈冷刀锥切术已经广泛应用于宫颈上皮内瘤变(cervicalin-traepithelialneoplasia,CIN)的诊治中。本研究旨在探讨普通电刀的宫颈锥切术在CIN和微小浸润癌的诊治中的临床应用价值。方法:回顾性分析2004年4月至2006年7月间在我院接受普通电刀的宫颈锥切术的173例患者的临床病理资料。记录手术时间、手术出血量,分析术后病灶残留、手术前后病理符合情况及再次手术情况。结果:173例患者平均年龄37.2岁(23~63岁),绝经3例,未生育者5例。手术中位时间为5min,中位出血量为5ml。锥切标本的病理诊断较阴道镜下活检或宫颈多点活检有降级或升级,各级别病变中手术前后的病理符合率为61.3%(25.0%~72.4%)。在163例术前诊为CIN的患者中,共发现9例微小浸润癌ⅠA1期,3例ⅠA2期。8例术前诊为微小浸润癌ⅠA1期中,3例间质浸润深度超过微小浸润癌范围被诊为局部早期浸润癌ⅠB1期。最后诊为ⅠA1期的14例患者中,1例切缘阳性者再次行锥切术,另有5例行次广泛全子宫切除术。所有ⅠA2期患者和ⅠB1期患者术后接受宫颈癌根治术。最后诊为CIN的151例患者中,3例切缘阳性,其中1例补充行全子宫切除术。2例术前活检阴性者锥切术后被证实为浸润性腺癌,另有3例CIN患者同时合并原位腺癌,术后均予再次手术。结论:应用普通电刀的宫颈锥切术是一种设备简单、手术时间短、出血少,且切净率高的诊治CIN和微小浸润癌的方法。其对宫颈微小浸润癌、局部早期浸润癌和腺癌的诊断率高。锥切术后为早期浸润癌或切缘阳性者,应根据具体情况进一步处理。
BACKGROUND & OBJECTIVE: Electrosurgical excision and cold knife conization have been widely used in the diagnosis and treatment of cervical intraepithelial neoplasia (CIN). The purpose of this study is to investigate the clinical value of cervical cone conization in the diagnosis and treatment of CIN and micro-invasive carcinoma. Methods: A retrospective analysis of clinical and pathological data of 173 patients with cervical conization undergoing general electric knife in our hospital from April 2004 to July 2006 was retrospectively analyzed. The operation time, the amount of bleeding after operation, the residual lesions after operation, the pathological findings before and after operation and the situation of reoperation were recorded. Results: The average age of 173 patients was 37.2 years (23-63 years), 3 were menopause, and 5 were not fertile. The median time of surgery was 5 minutes and the median amount of bleeding was 5ml. Cone-cut specimens pathological diagnosis than colposcopy biopsy or cervix multi-point biopsy was downgraded or upgraded at all levels of pathology in the preoperative and postoperative pathological coincidence rate was 61.3% (25.0% ~ 72.4%). Of the 163 patients with CIN preoperatively diagnosed, there were 9 cases of minimally invasive carcinoma, stage IA, and 3 cases of stage IA. Among the 8 patients who underwent preoperative diagnosis of minimally invasive carcinoma, in the stage of stage IA, three cases of invasive depth of invasion over the extent of micro-invasive carcinoma were diagnosed as local early invasive carcinoma stage IB. Of the 14 patients who were finally diagnosed as stage IA, one patient with a positive margin underwent conization again, and another 5 received extensive hysterectomy. All stage IA patients and stage IB patients underwent radical surgery for cervical cancer. Of the 151 patients who were finally diagnosed with CIN, 3 had a positive margins, of which 1 was complemented by a total hysterectomy. Two cases of negative biopsy before biopsy confirmed invasive ductal adenocarcinoma, and another three cases of CIN patients with adenocarcinoma of the same place, after surgery were reoperation. Conclusions: Cervical conization using ordinary electric knife is a simple method, short operation time, less bleeding, and the high rate of clean CIN and microinvasive invasive cancer method. Its micro-invasive cervical cancer, local early invasive carcinoma and adenocarcinoma of the high diagnosis. Cone incision for early invasive cancer or positive margin, should be further processed according to the specific circumstances.