冷刀锥切术后切缘阴性的临床分析.docVIP

冷刀锥切术后切缘阴性的临床分析 　　[摘要] 目的 探讨CINⅢ、早期浸润癌冷刀锥切术后切缘阴性在临床中的指导意义。 方法 对首都医科大学附属北京天坛医院妇产科2008年1月～2014年3月间冷刀锥切术后行再次手术的56例患者进行分析，52例患者行全子宫切除术，4例患者行广泛全子宫、双附件切除术及盆腔淋巴结清扫术，术前术后标本进行病理分析，其中CINⅢ52例，早期浸润癌4例。 结果 冷刀锥切术后再次手术标本中为炎症的36例（64.29%）；有病变残存者20例（35.71%），其中，16例病变降级，4例病变符合。4例早期浸润癌患者中，再次术后标本病理表现炎症2例，降级2例。 结论 切缘虽为阴性但仍有病变残存的可能，对于宫颈锥切术后切缘阴性的患者要综合患者年龄、心理状况及有无生育要求等全面分析，必要时行全子宫切除术是可行的。 　　[关键词] CIN；早期浸润癌；冷刀锥切术；切缘阴性 　　[中图分类号] R737.33 [文献标识码] B [文章编号] 1673-9701（2014）33-0143-02 　　[Abstract] Objective To evaluation the clinical significance of negative margin in patient with stage Ⅲ cervical intraepithelial neoplasia or early invasive carcinoma after cold-knife conization. Methods A total of 56 cases who had been treated by CKC due to CINⅢ or microinvasive carcinomaun derwent subsequent reoperation from January 2008 to March 2014. 52 cases with StageⅢ Cervical Intraepithelial Neoplasia derwent hysterectomy， 4 cases with early invasive carcinoma derwent extensive hysterectomy，bilateral adnexectomy，pelvic lymph node dissection. Results The 36 out of 56 cases（64.29%） were diagnosed with noresidual lesions after repeated operation. 20 cases（35.71%） had lesions lower than that of conization. 16 cases had degraded residual disease. 4 cases had consistent lesions. 2 cases with microinvasive carcinomaun had not residual lesions. 2 cases of them had degraded residual lesions. Conclusion Although the margin was negative but it is impossible for them to have residual lesions. To comprehensive patient age， psychological status and presence of fertility requirements， total hysterectomy is feasible. 　　[Key words] Cervical intraepithelial neoplasia；Early invasive carcinoma；Cold-knife conization；Negative margin 　　宫颈锥切术对高度上皮内瘤变（cervical intraepithelial neoplasia，CIN）和早期浸润癌既有诊断也有治疗作用，是宫颈癌筛查的重要阶梯。本文现总结首都医科大学附属北京天坛医院妇产科56例患者的临床资料，探讨宫颈锥切术后切缘阴性的意义。 　　1 对象与方法 　　1.1 研究对象 　　对首都医科大学附属北京天坛医院妇产科2008年1月～2014年3月间冷刀锥切术后再次手术的56例患者标本进行病理分析，年龄39～64岁，平均（47±6.36）岁。其中≤40岁5例，占8.9%；年龄60岁4例，占7.1%。 　　1.2 宫颈锥切术操作流程 　　静脉