I_(a1)期宫颈癌诊治策略的探讨  

Study on diagnosis and treatment strategy of stage I_(a1) cervical cancer

作　　者：王应海[1] 张红平[1] 李春琳[1] 卢义函 李航[1] 

机构地区：[1]云南省肿瘤医院妇科,云南昆明650500

出　　处：《现代肿瘤医学》2017年第20期3283-3286,共4页Journal of Modern Oncology

摘　　要：目的:探讨I_(a1)期宫颈癌诊治策略的选择。方法:对云南省肿瘤医院90例病理诊断为I_(a1)期宫颈癌患者病例资料进行回顾性分析。结果:阴道镜下宫颈活检诊断I_(a1)期宫颈癌35例,符合率为38.89%(35/90)。76例患者行冷刀锥切术(cold kinfe conization,CKC),术后病理诊断均为宫颈癌I_(a1)期,23例患者年轻、有生育要求,选择密切随访。53例因无生育要求,补充行子宫切除。76例患者中5例失访,其余随访过程无复发证据。14例患者行阴道镜下宫颈环形电切术(loop electrosurgical excision procedure,LEEP),术后诊断与原诊断均相符,术后补充子宫切除,14例患者中1例失访,其余随访过程无复发证据。结论:阴道镜联合宫颈活检诊断I_(a1)期宫颈癌存在局限性,宫颈锥切是诊断过程中不可省略的重要部分。CKC对有保留生育意愿的患者是可行、有效的治疗方式,但要严格把握手术适应证,无生育要求的I_(a1)期宫颈癌患者建议子宫切除。对于无生育要求的I_(a1)期宫颈癌患者,阴道镜联合LEEP可能是取代冷刀锥切,简化诊疗过程的一种尝试。Objective：To explore the strategy of diagnosis and treatment of stage Ial cervical cancer. Methods：A retrospective analysis was made on 90 cases of cervical intraepithelial neoplasia diagnosed as Ial in Yunnan Cancer Hospital. Results ：35 cases were diagnosed as Ial cervical cancer by the colposcopic submucosal cervical biopsy, the coincidence rate was 38.89% （35/90）. 76 patients underwent cold knife conization, all the patients were diagnosed as cervical cancer stage Ial, 23 patients were younger and had fertility requirements, close follow -up. 53 cases with no fertility requirements received additional hysterectomy. In the 76 patients, 5 patients were lost contact, others showed no evidence of relapse. 14 patients had eolposcopie LEEP surgery whose postoperative diagnosis and the original diag- nosis were consistent,with an additional hysterectomy. 13 of 14 had follow - up process without evidence of recur- rence. Condusion：Colposcopy combined with cervical biopsy in the diagnosis of cervical cancer Ial has limitations, and cervical conization is an important part of the diagnosis that can not be omitted. Cervical cold knife conization （CKC） is a practicable and effective treatment for those who have the will to keep fertility, but the indications for sur- gery should be strictly followed. For those who had no fertility requirements of Ial cervical cancer patients, hysterecto- my is recommended. Patients with no fertility requirements, we suggest that cold knife conization can be replaced by colposcopy LEEP which is an attempt to simplify the diagnosis and treatment process of Ial cervical cancer.

关 键 词：宫颈癌 宫颈冷刀锥切 宫颈环形电切术 

分 类 号：R737.33[医药卫生—肿瘤]