宫颈锥切术诊治宫颈上皮内瘤样变III级98例分析.PDFVIP

窑1642窑 南方医科大学学报(JSouthMedUniv) 2010;30(7) 宫颈锥切术诊治宫颈上皮内瘤样变III级98例分析 陈 为袁关 婷渊广州军区广州总医院妇产科袁广东广州 510010冤 摘要院 目的 探讨宫颈上皮内瘤样变III级CINIII合理的确诊及治疗方法遥 方法 回顾性分析我院2000 年 1月~2008 年12月收治的98例经阴道镜下宫颈活检初诊为渊CINIII冤的确诊方法袁治疗方式及随访结果遥 结果渊1冤98例患者入 院均接受宫颈锥切术渊53例行冷刀锥切袁45 例行LEEP术冤袁15例渊15.3%冤锥切术后病理检查较宫颈活检病变级别升高 为宫颈浸润癌遥渊2冤锥切术后52例接受全子宫切除术袁术后病理检查与锥切术后病理检查比较有显著性差异渊P0.01冤袁 无病变级别升高袁且仅4 例残余子宫有CINIII病变残留遥渊3冤31例因有生育要求或年轻拒绝行全子宫切除术袁选择锥 切术后门诊随访袁1例原位癌患者随访3年后CINIII 复发而行全子宫切除术袁其余随访患者渊包括全子宫切除术后患 者冤无复发遥 结论 宫颈锥切术是诊断CINIII 的金标准袁不能被阴道镜下宫颈活检所取代遥如宫颈锥切范围足够袁切缘 无病变残留袁能定期随访袁锥切术亦可作为CINIII 的首选治疗方法遥 关键 院宫颈上皮内瘤样变曰宫颈锥切术曰宫颈原位癌 中图分类号院R737.33 文献标识码院A 文章编号院1673-4254渊2010冤07-1642-03 DiagnosisandtreatmentofgradeIIIcervicalintraepithelialneoplasiabycervicalconization in98patients CHENWei, GUANTing DepartmentofObstetricsandGynecology,GuangzhouGeneralHospitalofGuangzhouCommand,Guangzhou510010,China Abstract: ObjectiveToexploretheoptimaldiagnosisandtreatmentmethodsforgradeIIIcervicalintraepithelilalneoplasia (CINIII).MethodsNinety-eightcasesofCINIIIinitiallydiagnosedbycolposcopicalbiopsyinourhospitalfrom2000to2008 wereanalyzedretrospectivelyintermsofthediagnosis, treatmentandoutcome. ResultsAllthepatientsreceivedcervical conizationincluding53withcoldknifeconizationand45withLEEPconization. Obviousdifferenceswerenotedbetween cervicalconizationandcolposcopicalbiopsyresultsin15cases (15.3%) diagnosedtobeinvasivecarcinoma. Fifty-two patientsreceivedhysterectomyafterconization. Asignificantdifferenceoccurredinpathologicaldiagnosisbetweencervical conization and hysterectomy groups (P0.01). There were low-grade cervical intraepithelilal lesions in most cases of hysterectomygroupandonly4caseshadCINIII. Thirty-onepatientsrefusedhysterectomyforconcernsoffertilityorbecause ofayoungageandwerefollowedupafterconization.Onepatientwithcervicalcarcinomainsituexperiencedrecurrencein3