子宫颈锥切术治疗子宫颈上皮内瘤变和Ⅰa1期子宫颈癌99例分析

    Treatment of cervical intraepithelial neoplasia and cervical cancer Ⅰa1 by cervical conization: analysis of 99 cases

    • 摘要: 目的:探讨子宫颈锥切术在子宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)及Ⅰa1期子宫颈癌诊治中的价值及其并发症的预防。方法:对99例CIN2~3级及Ⅰa1期子宫颈癌患者采用冷刀或电刀锥形切除子宫颈的治疗方法,分析手术治疗效果、手术并发症及其相关因素。结果:CIN2级患者锥切术后有20%(6/30)升为CIN3级。锥切术后发现CIN3级合并早期浸润癌者占8.96%,锥切术前后病理诊断完全符合率为72.73%。单纯行子宫颈锥切术的92例患者随访至2007年1月30日无一例复发。术后早期出血发生率18.48%,晚期出血发生率9.78%,感染发生率4.34%。术后成功妊娠分娩率44.0%。结论:子宫颈锥切术后病理诊断与术前子宫颈多点活检病理诊断仍有不同;对子宫颈病变范围较大,阴道镜诊断不满意的CIN2级患者行子宫颈锥切术,既可进一步明确诊断,又可彻底切除病灶。对年轻、要求保留生育功能的CIN 3级患者行子宫颈锥切术是安全、有效的治疗方法,其并发症通过提高手术技巧可以预防。

       

      Abstract: Objective: To explore the clinical value of cervical conization in treatment of cervical intraepithelial neoplasia(CIN) and stage Ⅰa1 of cervical cancer,and the measures to prevent complication.Methods: Ninety-nine cases of CIN 2-3 and cervical cancer Ⅰa1 were treated by cold knife conization(CKC) or electric knife conization.The surgical effect,complication and correlative factors were analyzed.Results: CIN 2 was altered to CIN 3 in 6 of the 30 cases(20%) after cervical conization,and CIN 3 accompanied by early invasive cervical cancer were observed in 6 of the 67 cases(8.96%) after cervical conization.The pathological examination results before and after cervical conization were in conformity in 72 of the 99 cases(72.73%).There was no recurrence after single cervical conization.The occurrence of postoperative bleeding was 18.48% in the early stage and 9.78% in the late stage,and the infection rate was 4.34%(4/92).The postoperative cyesis rate was 44.0%.Conclusions: There is still obvious difference between the pathological diagnosis after cervical conization and multiple biopsy diagnosis before operaion.For the CIN 2 patients with large extent of disease or uncertain diagnosis by colposcope,cervical conization can not only help to confirm the diagnosis,but remove the focus completely.It is also a safe and effecive therapy for CIN 3 patients who yearn to have children.The surgical complication could be prevented by surgical skills.

       

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