两种子宫颈锥切术治疗子宫颈癌前病变疗效及对保留生育功能影响研究  

Effects of two kinds of conizations of cervix in the treatment of precancerous lesions of the cervix and its influence on fertility preservation

作　　者：史凡黎 王敏[1] 尹宏岩 曾志[1] SHI Fan-li;WANG Min;YIN Hong-yan;ZENG Zhi(Department of Obstetrics and Gynecology,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院妇产科,辽宁沈阳110004

出　　处：《中国实用妇科与产科杂志》2019年第6期702-705,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：盛京自由研究者基金-6(MF68)

摘　　要：目的探讨冷刀-电刀-冷刀子宫颈锥切术(C-E-CKC)与冷刀锥切术(CKC)治疗子宫颈癌前病变的疗效以及对保留生育功能的影响。方法收集2013年1月至2017年1月在中国医科大学附属盛京医院因子宫颈上皮内瘤变(CIN)2、CIN3行子宫颈锥切术的患者138例作为研究对象,分为C-E-CKC组(81例)和CKC组(57例),比较两组患者的手术时间、术中出血量、切除锥体长度、手术前后病理符合率、切缘阳性率、术后病变残留和复发率、术后并发症发生率、妊娠情况及结局。结果 C-E-CKC组与CKC组的手术时间分别为(29.60±5.98)min和(33.67±5.95)min;术中出血量分别为(14.01±12.00)mL和(19.56±16.10)mL;C-E-CKC组Ⅰ、Ⅱ、Ⅲ型转化区切除锥体长度分别为(1.56±0.18)cm、(1.58±0.24)cm和(1.67±0.29)cm,CKC组分别为(1.71±0.34)cm、(1.80±0.37)cm和(2.20±0.27)cm,上述指标两组间差异均有统计学意义(均P<0.05)。两组患者手术前后病理符合率、切缘阳性率、术后病变残留及复发率、术后并发症发生率及妊娠结局等比较,差异均无统计学意义(均P>0.05)。结论两种手术方法治疗子宫颈癌前病变CIN2、CIN3均安全有效;C-E-CKC手术时间短,术中出血少,切除子宫颈组织小,对子宫颈的创伤更小,可能更适合于保留生育功能。Objective To discuss the effects of C-E-CKC and CKC in treating precancerous lesions of the cervix(CIN2,CIN3)and its influence on fertility preservation.Methods Select 138 patients who accepted conization of cervix with CIN2,CIN3 from January 2013 to January 2017 in our hospital,the C-E-CKC group consisted of 81 cases and the CKC group 57 cases.Compare the average operation time,the average intraoperative blood loss,cone length,the preoperative and postoperative pathological coincidence rates,the positive rate of the tangent margin,the rate of the recurrence rate,postoperative complications rate,and the pregnancy situation and outcome of two groups.Results The average operation time of C-E-CKC and CKC group was(29.60±5.98)min and(33.67±5.95)min,respectively,and the average intraoperative blood loss was(14.01±12.00)mL and(19.56±16.10)mL.In C-E-CKC group,the conical excision length of type I,Ⅱ and Ⅲ transformation zone was(1.56±0.18)cm,(1.58±0.24)cm and(1.67±0.29)cm,while in CKC group,it was(1.71 ±0.34)cm,(1.80±0.37)cm and(2.20±0.27)cm,and the differences between the groups were statistically significant(P<0.05).There was no significant difference in the preoperative and postoperative pathological coincidence rates,the positive rate of the tangent margin,the recurrence rate,postoperative complications rate or the pregnancy outcome between the two groups(P>0.05).Conclusion The two methods are both safe and effective for treating precancerous lesions of the cervix(CIN2,CIN3).C-E-CKC is with shorter operation time,less intraoperative bleeding and smaller excision of cervical tissue,and the damage to cervix is smaller,which is more suitable for patients to preserve fertility.

关 键 词：子宫颈癌前病变 冷刀-电刀-冷刀子宫颈锥切术 冷刀子宫颈锥切术 保留生育功能 

分 类 号：R737.3[医药卫生—肿瘤]