绝经后宫颈高级别鳞状上皮内病变手术方式的选择研究  

Selection of surgical methods for cervical high-grade squamous intraepithelial lesions after menopause

作　　者：黄陆荣 林青平 HUANG Lurong;LIN Qingping(Department of Gynecology,Xiamen Maternal and Child Health Care Hospital of Fujian Province,Women′s and Children′s Hospital Affiliated to Xiamen University,Xiamen,Fujian,361000)

机构地区：[1]福建省厦门市妇幼保健院/厦门大学附属妇女儿童医院妇科,福建厦门361000

出　　处：《实用临床医药杂志》2023年第11期28-31,共4页Journal of Clinical Medicine in Practice

摘　　要：目的探讨绝经后宫颈高级别鳞状上皮内病变(HSIL)患者手术方式的选择方案。方法回顾性分析宫颈HSIL行宫颈冷刀锥切和子宫切除手术293例患者的临床资料。比较绝经后患者阴道镜活检及锥切病理准确性,比较绝经后女性宫颈HSIL患者活检及锥切后筋膜外全子宫切除或广泛性全子宫切除发生率。结果绝经后女性锥切后病理符合率高于活检符合率。对于宫颈上皮内瘤变(CIN)Ⅱ级患者,根据活检和锥切结果进行手术选择,患者结局差异无统计学意义(P>0.05)。对于CIN Ⅲ级患者,根据活检和锥切结果进行治疗,患者结局差异有统计学意义(P<0.05)。结论绝经后女性活检后病理与最终病理符合率显著低于锥切后病理与最终病理符合率。绝经后女性活检病理类型为CIN Ⅱ级且锥切手术困难者,建议行筋膜外全子宫切除;CIN Ⅲ级者建议先行宫颈冷刀锥切术,再根据锥切病理决定进一步诊疗方案。Objective To explore the surgical methods for patients with cervical high-grade squamous intraepithelial lesions(HSIL)after menopause.Methods Clinical materials of 293 patients with cervical cold-knife coning and hysterectomy forcervical HSIL were retrospectively analyzed.The pathological accuracy of colposcopic biopsy and coning resection in postmenopausal patients was compared,and the incidence rates of biopsy and extrascial total hysterectomy orextensive hysterectomy in postmenopausal patients with cervical HSIL were compared.Results The pathological coincidence rate of postmenopausal women afterconing was higherthan biopsy.Forcervical intraepithelial neoplasias(CIN)Ⅱ patients,there was no significant difference in the outcome of surgical selection based on biopsy and conical incision results(P>0.05).For CIN Ⅲ patients,treatment based on biopsy and conical incision results showed a significant difference in outcomes(P<0.05).Conclusion In postmenopausal women,the coincidence rate between post-biopsy pathology and final pathology is significantly lowerthan that between pathology and final pathology afterconical resection.For postmenopausal women with CIN Ⅱ biopsy pathology and difficulty in conical resection surgery,total extrascial hysterectomy is recommended;for CIN Ⅲ patients,cold knife conical resection of cervix is recommended first,and further diagnosis and treatment plan is determined according to the conical pathology.

关 键 词：绝经 宫颈高级别鳞状上皮内病变 筋膜外全子宫切除术 广泛性全子宫切除术 宫颈锥形切除术 阴道镜活检 

分 类 号：R711.74[医药卫生—妇产科学] R713.4[医药卫生—临床医学]