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目的探讨宫颈冷刀锥切术(CKC)在宫颈上皮内瘤变2/3级(CIN2/3)诊治中的意义及病变残存的高危因素。方法回顾性分析347例宫颈CKC患者的临床资料,分析宫颈CKC后切缘状态、病变累及腺体与宫颈病变残存的关系,探讨宫颈锥切的诊治效果。结果 47例CIN2患者行CKC,病理与宫颈活检的符合率为25.5%,22例(46.8%)升级,其中有2例升级为浸润癌。300例CIN3患者行CKC,190例(63.3%)病理与活检相符,24例(8.0%)升级为浸润癌。其中的122例患者进行子宫切除术,31例(25.4%)病变残存,19例(15.6%)降级。锥切切缘阳性者再次术后的病变残存率高于切缘阴性者(62.5%vs.22.8%)(P<0.05)。累及腺体和未累及腺体者再次术后病变残存率相仿(26.4%vs.22.9%)(P>0.05)。结论宫颈CKC在CIN2/3级的诊治中有重要价值。宫颈锥切术后切缘阳性是病变残存的高危因素;累及腺体与病变残存无相关性。
Objective To investigate the significance of cervical conization (CKC) in diagnosis and treatment of cervical intraepithelial neoplasia grade 2/3 (CIN2 / 3) and the risk factors of residual disease. Methods The clinical data of 347 cases of cervical CKC were retrospectively analyzed. The relationship between the status of margins and the lesions of gland and cervical remnant lesions was analyzed after cervical CKC, and the diagnosis and treatment of cervical conization were discussed. Results 47 cases of CIN2 patients underwent CKC, the pathology and cervical biopsy coincidence rate was 25.5%, 22 cases (46.8%) escalation, of which 2 cases escalated to invasive carcinoma. CKC was performed in 300 patients with CIN3, and the pathology was consistent with biopsy in 190 patients (63.3%). 24 patients (8.0%) were upgraded to invasive carcinoma. Of the 122 patients who underwent hysterectomy, 31 (25.4%) survived and 19 (15.6%) survived. The residual remnant rate after resection was higher than those with negative margins (62.5% vs.22.8%) (P <0.05). Recurrence rates of resected lesions were similar in patients with and without glands (26.4% vs.22.9%, P> 0.05). Conclusion Cervical CKC is of great value in diagnosis and treatment of CIN2 / 3. Cervical conization positive margin is the risk factors for residual disease; involvement of the gland and the disease remains unrelated.