宫腔镜电凝辅助宫颈冷刀锥切术在CINⅢ的临床观察  

Clinical analysis of hysteroscopic coagulation adjuvant cervical cold knife conization for grade Ⅲ cervical intraepithelial neoplasia

作　　者：李晶华[1] 冯力民[1] 吴玉梅[2] 杨保军[1] 赵群[2] 王伟娟[1] 高婉丽[1] 赵卫红[1] 邢凤玲[1] 

机构地区：[1]首都医科大学附属北京天坛医院妇产科,北京100050 [2]首都医科大学附属北京妇产医院肿瘤科,北京100026

出　　处：《癌症进展》2011年第4期428-432,共5页Oncology Progress

摘　　要：目的探讨宫腔镜电凝辅助宫颈冷刀锥切术(cold knife conization,CKC)在重度宫颈上皮内瘤变(cer-vical intraepithelial neoplasiaⅢ)诊断治疗中的临床意义。方法回顾性分析134例CINⅢ患者,通过宫腔镜电凝辅助CKC和传统CKC的方法,了解患者术前组织活检与术后病理情况,术中术后临床观察及术前术后HPV表达变化情况。结果 134例患者中,78例行宫腔镜电凝辅助CKC,56例行传统CKC。宫腔镜电凝辅助CKC和传统CKC术后组织病理结果与术前多点活检完全符合率分别为78.21%(61/78)和75%(42/56);两组切缘病变残留率分别为6.41%(5/78)和7.14%(4/56)。术中出血分别为:19.25±10.59ml和33.63±14.56ml;手术时间分别为:14.02±4.079分钟和25.09±7.034分钟;术后并发症:出血分别为2例(均为术后2周左右)和3例(2例术后当日,1例术后2周);两组均无感染。随访6个月至4年,HPV在宫腔镜电凝辅助CKC术后3个月64例(术前72例阳性)转为阴性,转阴率为89%(64/72),传统CKC术后3个月43例(术前50例阳性)转为阴性,转阴率为86%(43/56)。两组随访至今HPV均为阴性。结论与传统的CKC相比,宫腔镜电凝辅助CKC术中出血少,手术时间短的优点,是目前治疗重度宫颈上皮内瘤变的一种较好的方法,值得推广。Objective To evaluate the clinical value of hysteroscopic coagulation adjuvant cervical cold knife coniza- tion （CKC） in the diagnosis and treatment of cervical intraepithelial neoplasia Ⅲ （ CIN m ）. Methods From January 2006 to August 2010, 134 patients with CIN Ⅲ underwent hysteroscopic coagulation adjuvant CKC （n =78 ） or traditional CKC （n = 56）. Intraoperative bleeding, operation time, morbidity, pathology biopsy and the changes in the expression of HPV were observed. Results For the patients treated with the hysteroscopic coagulation adjuvant CKC and traditional CKC. the postoperative pathologic findings were identical to the preoperative one in 61 cases （78.21% , 61/78 ） and 42 cases （75% 42/56） respectively; positive margin prevalence were 6.41% （5/78）and 7. 14% （4/56）, respectively; intraoperative bleeding were （ 19.25 ± 10. 59） ml and （33.63 ± 14. 56） ml, respectively; and operation time was （ 14.02 ±4. 079） min and （ 25.09 ±7.034 ） miu, respectively. Postoperative complications ： bleeding in 2 cases （ both after 2 weeks） by hysteroseopie coagulation adjuvant CKC and 3 cases （2 cases within 24 h, one after 2 weeks） by traditional CKC. There was no infection. The patieaes were followed up 6-48 months. In 64 patients, HPV became negative （72 pa-tients with preoperative positive） in hysteroscopic coagulation adjuvant CKC, and the negative conversion rate were 89% （64/72）. However, in traditional CKC. 40 cases became negative （50 patients with preoperative positive）, and the neg- ative conversion rate were 86% （43/50）. During the follow-up, HPV were all negative in the two groups. Conclusion Hysteroscopic coagulation adjuvant cervical CKC has less blood loss and operation time, compared with traditional CKC. It is an effective treatment for severe cervical intraepithelial neoplasia.

关 键 词：宫颈上皮内瘤变 宫颈冷刀锥切术 宫腔镜 HPV 

分 类 号：R737.33[医药卫生—肿瘤]