摘要
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（cervical intraepithelial neoplasia，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 and purpose： High frequency loop electrosurgical excision procedure（LEEP） and cold-knife conization （CKC） have been widely used in the treatment of cervical intraepithelial neoplasia （ CIN）. The aim of this study was to investigate the clinical application of general electrosurgical conization in the management of CIN and microinvasive carcinoma. Methods： A retrospective study was carried out in 173 cases with CIN and microinvasive carcinomas, who undertook general electrnsurgical conization at the Cancer Hospital of Fudan University between April 2004 and July 2006. The clinico-pathological data were analyzed. Results： The mean age of the 173 cases was 37.2 years old （23 ～63）, including 3 menopausal women and 5 nulliparous women. The median operation duration was 5 min （4 -20min） and the median volume of blood loss was 5ml （mini -200 ml）. The histopathological diagnose of cone specimens and muhiple biopsies were consistent in 106 patients （61.3%）. The coincidence rate of the pre- and post-conization histopathology ranged from 25.0% -72.4% among CIN1-3 and microinvasive carcinomas. Among 163 cases with CIN diagnosed by biopsies before operation, 9 cases were diagnosed as microinvasive carcinoma ⅠA1 and 3 cases were diagnosed as ⅠA2. In 8 cases with microinvasive carcinoma ⅠA1 diagnosed by biopsies, 3 cases had stromal invasion deeper than 5 mm and were diagnosed as locally invasive carcinoma ⅠB1 by conization before operation. Among all 14 of stage ⅠA1 cases, 1 case received secondary conization due to positive margin, and 5 of stage ⅠA1 cases were further treated with subradical hysterectomy. All of stage ⅠA2 and ⅠB1 cases received radical hysterectomy and bilateral pelvic lymphadenectomy. There were 151 patients to be diagnosed with CIN, residual tumors were found in 3 CIN cases. One of them was later treated with total hysterectomy. Another 2 of them was confirmed as infiltrating adenocarcinoma after conization. There were 3 CIN cases with adenocarcinoma in situ at the same time. Conclusions： General electrosurgical conization is an effective procedure in the management of CIN and microinvasive carcinomas. The procedure just need simple equipment, could be finished within a short time without much blood loss. Patients suspected of microinvasive, locally invasive carcinoma and adenocarcinoma should be diagnosed by conization, further treatment is needed if patients have positive margin after conization and microscopic invasive carcinoma.
出处
《中国癌症杂志》
CAS
CSCD
2006年第11期922-925,共4页
China Oncology
关键词
宫颈上皮内瘤变
微小浸润癌
普通电刀
宫颈锥切术
cervical intraepithelial neoplasia （CIN）
microinvasive carcinoma
general electrosurgical conization
