子宫颈冷刀锥切术在子宫颈癌诊断和治疗中的作用  

Clinical evaluation of cold knife conization for diagnosis and treatment of cervical cancer

作　　者：赵超[1] 王世言[1] 刘硕[1] 孟冲 王建六[1] 魏丽惠[1] 

机构地区：[1]北京大学人民医院妇产科,100044

出　　处：《中国妇产科临床杂志》2017年第6期489-492,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：国家关键技术研发项目(2015BAI13B06);北京大学人民医院研究与发展基金(RDC2015-18)

摘　　要：目的探讨宫颈冷刀锥切术对宫颈癌的诊断价值及治疗作用。方法回顾性分析2008年1月至2016年9月于北京大学人民医院行宫颈冷刀锥切术1 292例患者中术后病理诊断为宫颈癌的125例患者的临床资料。结果 (1)125例宫颈癌患者中,鳞状细胞癌116例(92.8%),其中ⅠA1期77例,ⅠA2期5例,ⅠB1期34例;腺癌为7例(5.6%),其中ⅠA1期3例,ⅠA2期2例,ⅠB1期2例(1例合并宫颈鳞癌ⅠB1期);宫颈神经内分泌癌和宫颈腺样基底细胞癌ⅠA1期各1例(0.8%,1/125)。(2)77例ⅠA1期宫颈鳞状细胞癌患者中,41例(53.2%)接受了全子宫切除术,术后病理14例(34.2%,14/41)有病灶残留,其中HSIL 13例(9例CIN2,4例CIN3),鳞状细胞癌1例;1例ⅠA1期宫颈腺癌接受了全子宫切除术。36例(46.8%)有生育要求的ⅠA1期鳞状细胞癌患者中,2例术后切缘为CIN2,2例术后切缘为CIN3,患者均拒绝再次手术。随访23~52个月,未见明显异常。43例ⅠA2期以上患者接受了宫颈癌根治术。已手术的85例患者除2例失访外,1例宫颈鳞癌ⅠA1期术后8年复发,其余未发现异常。结论宫颈冷刀锥切术在宫颈癌的诊断和治疗中具有重要价值,对宫颈锥切术切缘阳性且无生育要求的ⅠA1期宫颈鳞状细胞癌患者可行子宫切除术,对宫颈锥切术切缘阴性者可保留子宫但需严密随访。Objective To evaluate the clinical value of cold knife conization in the diagnosis and treatment of cervical cancer patients. Methods 125 patients diagnosed as cervical cancer after cold knife conization in our hospital between Jan 2008 and Sep 2016 were reviewed. The pathological profiles of conization specimens and treatment options were analyzed. Results There were 116 cases of squamous cell carcinomas, 7 adenocacinomas, 1 neuroendocrine carcinoma and 1 adenoid basal carcinoma. In the 116 squamous cell carcinomas, there were stage Ial （n = 77）, stage Ia2 （n=5） and stage Ibl （n =34）. In 7 adenocacinomas, there were stage Ial （n = 3）, stage Ia2 （n=2） and stage Ibl （n =2）. Among 41 patients of stage Ial squamous cell carcinomas undergoing further surgery, 14 （34.2%） had residual diseases, including CIN 2 （n = 9）, CIN3 （n = 4） and squamous cell carcinoma （n = 1）. No recurrence was found in 36 cases without further surgical intervention. Conclusion Cold knife conization could play a very important role in the diagnosis and treatment of cervical cance. Further treatment options should be selected individually and comprehensively based on such factors as patient＇s age, degrees of dysplasia, surgical margin status, fertility requirements etc.

关 键 词：子宫颈癌 子宫颈锥形切除术 残留病灶 再次手术 

分 类 号：R737.33[医药卫生—肿瘤]