宫颈上皮内瘤变Ⅲ级病变外科手术治疗的合理选择  

Reasonable surgical approach for grade Ⅲ cervical intraepithelial neoplasia

作　　者：吴湘[1] 崔毅[1] 龚颖萍[1] 许海南[1] 蒋丹[1] 孟胜君[1] 

机构地区：[1]湖南省妇幼保健院妇科,长沙410008

出　　处：《中南大学学报（医学版）》2012年第8期824-828,共5页Journal of Central South University ：Medical Science

摘　　要：目的:探讨宫颈上皮内瘤变Ⅲ级(CINⅢ)的临床病理特点与宫颈锥切手术方式的合理选择。方法:回顾性总结2005年8月至2010年12月在湖南省妇幼保健院院行治疗的383例CINⅢ患者,随机行冷刀宫颈锥切术治疗213例,行普通电刀宫颈锥切术治疗170例,比较临床病理资料和预后随访资料。结果:电刀锥切组和冷刀锥切组两种手术方式在所切下宫颈锥体的直径及锥高方面的差异均无统计学意义(P>0.05)。术中出血量分别为(13.1±5.2)mL和(25.5±17.2)mL,电刀锥切组的出血量比冷刀锥切组减少50%,差异有统计学意义(P<0.01)。383例锥切术后病理检查,350例没有病理升级,33例出现了病理升级,被确诊为Ⅰa1期宫颈浸润癌21例,Ⅰa2期宫颈浸润癌7例,Ⅰb1期宫颈浸润癌5例。Ⅰa1期宫颈癌中,3例(14.3%)有生育要求且切缘阴性的患者宫颈锥切术后接受严密随诊,1例(4.8%)切缘阳性但有生育要求的患者进行了再次锥切,其余17例(80.9%)实施筋膜外全子宫(或加双附件)切除。Ⅰa2期和Ⅰb1期宫颈癌中12例全部进行了根治性切除术。随诊383例患者未见有肿瘤的复发。结论:CINⅢ患者常规依据病理诊断结果和个体化要求,有选择性地实施单纯宫颈锥切术或全子宫切除手术方式安全可行。Objective： To analyze the clinical pathologic characteristics of cervical intraepithelial neoplasia grade Ⅲ（CINⅢ） and to explore optimal surgery for CINⅢ patients. Methods： The clinical pathologic characteristics,surgical treatments,prognosis and history of 383 CINⅢ patients,who hospitalized from August 2005 to December 2010,were reviewed and analyzed.Among the patients,213（55.6%） received cold-knife conization surgery and 170（44.4%） received ordinary electric knife conization surgery. Results： There was no significant statistic difference between cold-knife conization group and ordinary electric-knife conization group on the level of clearance of the pathologic tissues and the cervical cone diameter and cone high.Intraoperative blood loss was（13.1±5.2） mL and（25.5±17.2） mL.Bleeding of electric knife conization group,compared with that of the cold knife conization group,decreased by nearly 50%.The difference between the 2 groups was significant（P〈0.01）.Pathological examination after conization operation indicated that 350 out of the 383 patients didn’t show pathological upgrade while 33 patients showed pathological development,among which 21 were diagnosed with invasive cervical cancer at Ⅰa1 clincal stage,7 atⅠa2 clincal stage and 5 atⅠb1 clincal stage.In 3 cases（14.3%） Ⅰa1 cervical cancer patients,fertility requirements and negative margins with cervical conization were closely followed up,and one patient（4.8%） with positive margin and fertility requirements had re-conecut.The remaining 17（80.9%） had resected the uterus outside the fascia（or plus attachments）.All the 12 patients with invasive cervical cancer at Ⅰa2 orⅠb1 clinical stage received radical hysterectomy.No tumor recurrence was observed in the 383 patients. Conclusion： Treatment optimazation of CINⅢ patients should be based on clinical pathological diagnosis and individual requirements.Both cervical conization surgery and total hysterectomy have been proved safe and practical

关 键 词：宫颈上皮内瘤变Ⅲ级 宫颈锥切手术 全子宫切除手术 

分 类 号：R737.33[医药卫生—肿瘤]