75例宫颈上皮内瘤变锥切术后病变残留或复发的临床特点及诊治分析  

An Analysis of Diagnosis and Treatment and Clinical Features of 75 Patients with Residual or Recurrent Disease after Conization for Cervical Intraepithelial Neoplasia

作　　者：宗丽菊 高绍凤[1,2] 韩赛[1] 李艺[1] 孟丽华[1] 张友忠[1] 孔北华[1] 

机构地区：[1]山东大学齐鲁医院,山东济南250012 [2]山东省单县中心医院,山东单县274300

出　　处：《实用妇产科杂志》2016年第9期676-680,共5页Journal of Practical Obstetrics and Gynecology

基　　金：国家自然科学基金(编号:81572559);山东省科技发展计划项目(编号:2014GGH218029)

摘　　要：目的：分析宫颈上皮内瘤变（CIN）锥切术后病变残留或复发病例的临床特点、诊治过程及预后情况。方法：收集75例宫颈锥切术后病变残留或复发病例的临床资料,分析患者初次锥切方法及术后病理、术后随访、二次手术情况,并分析再次复发患者的诊治。结果：75例宫颈锥切术后病变残留或复发患者平均年龄40.4岁,36例（48.0%）的患者年龄集中在40-50岁,病变残留或复发间隔时间平均18个月,58例（77.3%）发生在术后24个月之内。病变残留或复发患者中仅47例（62.7%）细胞学提示异常,73例（97.3%）HPV DNA阳性。35例病变残留或复发者接受子宫切除术,40例接受保留子宫的宫颈锥切术或部分宫颈切除术,其中20.0%（8/40）在术后2年内再次出现病变残留或复发并接受第3次手术治疗。结论：大部分CIN病变残留或复发在锥切术后2年内发生,患者年龄主要在40-50岁;HPV检测诊断病变残留或复发的阳性率高于宫颈细胞学;再次宫颈锥切术是治疗病变残留或复发的有效手段,但仍有再次病变残留或复发的风险。Objective：To analyse the clinical and pathological characteristics,diagnosis,treatment and prognosis in 75 patients with residual/recurrent disease after conization for cervical intraepithelial neoplasia. Methods： Medical records and pathological slides form 75 patients with cervical intraepithelial neoplasia were reviewed,and the following parameters were analysed including initial conization,post-cone follow-up results;the diagnosis and treatment for second residuaVrecurrent disease. Results： The average age of 75 patients was 40.4 years, 48.0% of who was 40 -50 years old. The average relapsing interval time was 18 months and 77.3% （58/75） patients were found with recurrence within 24 months after operation,while cytology test from 62.7% （47/75） recurrent patients was abnormal. Seventy-three（97.3% ） patients were positive of HPV DNA. A total of 35 patiens received hysterectomy and 40 received uterine-preserving cervical conization or partial trachelectomy, while 20.0% （8/40） of the latter presented recurrence during follow-up of two years after the second surgery and received the third operation. Conclusions： Most of the residual or recurrent CIN lesions occur within 2 years after conization, mainly in 40 -50 years. The sensitivity of HPV detection in diagnosis of residual or recurrent diseases was significantly higher than that of cervical cytology. Repeated conization was an effective means of treatment for residual or recurrent disease,but there were still risks of a relapse.

关 键 词：宫颈上皮内瘤变 宫颈锥切术 病变残留 复发 

分 类 号：R711.74[医药卫生—妇产科学]