宫颈部分切除术治疗宫颈上皮内瘤变残留和复发效果  

PARTIAL RESECTION OF CERVIX IN PATIENTS WITH RESIDUAL OR RECURRENT CERVICAL INTRAEPITHELIAL NEOPLASIA

作　　者：孔守芳[1] 戴淑真[2] 孙选[1] 姚勤[2] 

机构地区：[1]青岛大学医学院附属青岛市海慈医疗集团妇科,山东青岛266033 [2]青岛大学附属医院妇科

出　　处：《齐鲁医学杂志》2015年第4期433-435,共3页Medical Journal of Qilu

基　　金：青岛市科技局科研基金资助项目(13-1-3-118-jcl)

摘　　要：目的探讨宫颈部分切除术和再次宫颈锥切术治疗宫颈上皮内瘤变（CIN）残留和复发的效果。方法因宫颈CINⅡ~Ⅲ期行宫颈锥切后复发病人55例,其中30例给予宫颈部分切除术（宫颈切除组）,25例行二次宫颈锥切术（宫颈锥切组）。术后随访,检测病人人乳头瘤病毒（HPV）、液基细胞学、组织学,并记录不良反应。结果随访半年,宫颈切除组无病人细胞学异常;宫颈锥切组病人4例细胞学异常（16%）,阴道镜活组织学检查无异常,两组比较差异有统计学意义（χ^2=4.49,P〈0.05）。随访1年,宫颈切除组无细胞学异常病人;宫颈锥切组8例（32%）鳞状上皮内高度病变,组织学证实复发,两组比较差异有统计学意义（χ^2=11.23,P〈0.05）。宫颈切除组半年内30例（100%）HPV感染转阴,宫颈锥切组15例（60%）转阴,两组比较差异有统计学意义（χ^2=14.66,P〈0.05）。宫颈切除组与宫颈锥切组相比较,术后不适症状发生率差异无显著性（P〉0.05）。结论宫颈部分切除术较再次宫颈锥切术能更好地预防CIN残留或复发。Objective To explore the significance of partial resection of cervix and re-conization for residual or recurrent cervical intraepithelial neoplasia（CIN）. Methods Fifty-five patients with post-conization recurrence of stageⅡ-Ⅲ CIN were enrolled,of whom,30 underwent partial resection of cervix（PRC）and 25 underwent second cervical conization（SCC）.Post-operative follow up was carried out to detect HPV,liquid-based cytology and histology,and record their adverse reactions. Results A followed up of six months showed no cytological abnormalities in PRC group,and in SCC group,cytological abnormalities were found in four（16%）patients,the difference was staistically significant（χ^2=4.49,P〈0.05）,vaginoscopic biopsy being normal.A follow-up of one year demonstrated that in PRC group,no patients with abnormal cytology were observed,and in SCC group,eight（32%）patients with abnormal cytology,with high pathological changes,confirming recurrence,the statistical difference between the two groups was significant（χ^2=11.23,P〈0.05）.With regard to HPV infection,within half year after surgery,30cases（100%）in PRC group returned to negetive,and in SCC group,15（60%）returned to normal（χ^2=14.66,P〈0.05）.There was no difference between the two groups in regard to post-operative unwell symptoms（P〉0.05）. Conclusion Partial resection of cervix is better than re-conization in terms of prevention of residual or recurrence of cervical intraepithelial neoplasia.

关 键 词：宫颈上皮内瘤样病变 锥形切除术 复发 

分 类 号：R711.74[医药卫生—妇产科学]