宫颈冷刀锥切术治疗宫颈上皮内瘤变Ⅲ级的效果评价  

Evaluation of Cervical Cold Knife Conization for Grade Ⅲ Cervical Intraepithelial Neoplasia

作　　者：郝增平[1] 陈瑛[1] 靳家玉[1] 

机构地区：[1]首都医科大学附属友谊医院妇产科,北京100050

出　　处：《中国微创外科杂志》2010年第7期620-622,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的评价宫颈冷刀锥切术(cold knife conization,CKC)对阴道镜活检结果为宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅲ级患者的诊治价值。方法回顾性分析2005年1月～2009年1月我院采用CKC治疗30例CINⅢ级患者的临床资料。术后1年内每3个月随访一次,包括细胞学检查[薄层液基细胞学检查(TCT)或超薄细胞学检查(CCT)]、人乳头瘤病毒(HPV)检测(杂交捕获)和妇科检查。若正常,以后每6～12个月随访一次。结果 CKC术后病理结果 29例与术前阴道镜下活检结果一致,符合率为96.7%,CINⅡ级1例,切缘干净无残留。术后3个月复诊,30例宫颈外形均恢复正常形态。术后3个月常规阴道镜检查,无一例复发。4例随访时间<1年,细胞学检查2例为炎症,2例为未明确诊断意义的不典型鳞状细胞(ASCUS),行阴道镜下宫颈活检,1例为炎症,1例为CINⅠ级,3个月后复查细胞学为炎症,阴道镜活检亦为炎症;随访1～3年20例,3～5年6例,细胞学均为正常或炎症。其中2例已妊娠并剖宫产分娩。并发症主要为出血5例(16.7%),包括术中出血1例、术后出血4例。结论 CKC是治疗CINⅢ的有效方法 ,并能提高宫颈病变诊断的准确性。Objective To evaluate the value of cervical cold knife conization （CKC） in the treatment of grade Ⅲcervical intraepithelial neoplasia （CIN） that were diagnosed by colposcopic biopsy. Methods A retrospective analysis of clinical data of 30 patients with CIN III,who underwent CKC in our hospital from January 2005 to January 2009,were carried out. All the patients were followed up quarterly during the first year,cytology （TCT or CCT）,HPV detection （hybrid capture）,and gynecological examinations were carried out each time. If the examinations showed normal results in the first year,from the second year,the patients received the examinations every 6 or 12 months. Results The postoperative CKC pathologic findings was identical to the pre-operative one in 29 cases （96.7%）. One patient showed CIN II,and a clean cutting edge without residual cancer tissues. Follow-up in 3 months showed normal cervix at gynecological examination,no recurrence was detected by colposcopy. Four patients were followed up less than 1 year,two of them were diagnosed with inflammation by cytology,and the other two were confirmed as having ASCUS,which was then diagnosed with inflammation and CIN I respectively. Twenty patients achieved a follow-up for 1 to 3 years,and 6 for 3 to 5 years. Cytological examination showed normal results or inflammation in all of these cases. Two of them gave birth by Cesarean section-during the follow-up. In our patients,5 patients had hemorrhage,one of them had blood loss during the operation,and the other 4 showed bleeding after the surgery. Conclusions CKC is an accurate diagnostic method and effective therapy for patients with CIN Ⅲ.

关 键 词：宫颈上皮内瘤变 宫颈冷刀锥切术 治疗 

分 类 号：R737.33[医药卫生—肿瘤]