48例阴式扩大性子宫颈切除术临床分析  

Clinical analysis of 48 patients with vaginal enlarged amputation of cervix

作　　者：曾四元[1] 李隆玉[1] 李诚信[1] 舒宽勇[1] 潘玫[1] 李汉萍[1] 罗兵[1] 安云婷[1] 梁美蓉[1] 吴云燕[1] 

机构地区：[1]江西省妇幼保健院肿瘤科,南昌330006

出　　处：《中华妇产科杂志》2008年第1期41-44,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨阴式扩大性宫颈切除术保守性治疗Ⅰa1期宫颈鳞癌及不适于行宫颈锥切术的宫颈上皮内瘤变（CIN）Ⅲ级患者的可行性及安全性。方法2002年7月-2007年5月，选择经环形电切术（LEEP）并活检后病理诊断的宫颈鳞癌Ⅰa1期（除外脉管癌栓）、大面积CINⅢ（阴道镜下病变面积≥3／4）、CINⅢ合并阴道上段上皮内瘤变（VAIN）、CINⅡ-Ⅲ锥切术后或LEEP术后复发、病变残存、切缘阳性，且要求保留子宫和（或）生育功能的患者，行阴式扩大性宫颈切除术治疗，对其临床资料进行分析。结果48例患者顺利实行阴式扩大性宫颈切除术，其中Ⅰa1期宫颈鳞癌患者5例，大面积CINⅢ患者38例（9例累及腺体），CINⅢLEEP术后病变残存2例、切缘阳性2例，CINⅡ锥切术后复发1例。患者年龄27-40岁，中位年龄34岁，平均手术时间60min（30-100min），平均出血量加ml（5-300ml），平均住院天数10d（7-17d）。随访1～39个月，随访时间的中位数为14个月，无术后并发症及复发病例。结论阴式扩大性宫颈切除术是一种保守性治疗Ⅰa1期宫颈鳞癌、大面积CINⅢ、CINⅢ合并VAIN以及CINⅡ-Ⅲ锥切术后复发、病变残存、切缘阳性等不适于行宫颈锥切术患者的、安全有效的术式。Objective To evaluate the feasibility and safety of vaginal enlarged amputation of cervix to treat patients with cervical cancer of stage Ⅰal and cervical intraepithelial neoplasia grade Ⅲ （ CIN Ⅲ ） who were unfit for conization surgery. Methods From July 2002 to May 2007, patients with cervical cancer at stage Ⅰ al, diagnosed by pathology after loop electrosurgical excision procedure （LEEP）, large area CIN Ⅲ （the area of lesion ≥ 3/4 on colposcopy ）, CIN Ⅲ coexisted with vaginal intraepithelial neoplasia （VAIN） in the superior segment of vagina, CIN Ⅱ - Ⅲ recurrence or with residual lesion, positive margin after conization of cervix, who wanted to preserve fertility and （or） corpus uteri were selected to receive vaginal enlarged amputation of cervix. Results Forty-eight cases including 5 with cervical cancer in stage Ⅰal, 38 with large area CIN Ⅲ （9 with gland involvement）, 2 with residual lesion and 2 with positive margin after LEEP, 1 recurrence after cold knife conization, received the procedure successfully. The median age was 34 years （ range 27 - 40 ）, median operation time was 60 minutes （ range 30 - 100 ）, median blood loss was 40 ml （ range 5 - 300）, and median hospital stay was 10 days （ range 7 - 17）. After follow-up 1 -39 months, no patient had postoperative complications and recurrence, and all patients resumed normal menstrual cycle and sexual life. Conclusion Vaginal enlarged amputation of cervix appears to be a safe and feasible procedure for patients with cervical cancer at stage Ⅰal and CIN Ⅲ who are unfit for conization surgery.

关 键 词：宫颈肿瘤 癌 鳞状细胞 宫颈上皮内瘤样病变 子宫颈 妇科外科手术 

分 类 号：R686[医药卫生—骨科学]