目的 对宫颈冷刀锥切术后再次行腹腔镜下全子宫切除术治疗的宫颈上皮内瘤变(CIN)Ⅲ患者进行临床分析,探讨CINⅢ宫颈冷刀锥切术后的进一步处理方法.方法 对101例CINⅢ患者的临床资料进行回顾性分析,均为宫颈冷刀锥切术后再次行腹腔镜下全子宫切除术的患者.结果 101例患者中,68例(67.3%)患者的阴道镜下宫颈活检及宫颈冷刀锥切术后病理结果相符,6例(5.9%)病理升级为浸润癌.宫颈冷刀锥切术后切缘阳性23例,切缘阴性78例.切缘阳性患者中,11例病灶残留,其中CINⅠ2例,CINⅡ2例,CINⅢ5例,早期浸润癌2例,病灶残存率为47.8%(11/23);切缘阴性患者中,7例病灶残留,其中CINⅠ4例,CINⅡ2例,CINⅢ1例,病灶残存率为9.0%(7/78).两者病变残存率比较差异有统计学意义(P<0.05).结论 阴道镜下宫颈活检有漏诊宫颈癌的风险,并不能代替诊断性宫颈冷刀锥切术.宫颈冷刀锥切术后切缘阴性仍有一定比例病灶残留,有复发或残留高危因素者可考虑进一步手术治疗.
Objective To analyze the clinical data of laparoscopic total hysterectomy after cervical cold knife conization (CKC) in patients with cervical intraepithelial neoplasia (CIN), and study the supplemental treatment methods after cervical cold knife conization in patients with CIN Ⅲ. Methods The clinical data of 101 patients with CIN Ⅲ were retrospectively analyzed, the patients were treatment with laparoscopic total hysterectomy after cervical cold knife conization. Results Among the 101 patients, the accordant pathological result of cervical biopsy under colposcopy and cervical cold knife conization was in 68 cases (67.3%), while 6 cases (5.9%) pathological upgraded to invasive carcinoma. The positive margins after cervical cold knife conization was in 23 cases, and negative margins was in 78 cases. Among the positive margins patients, 11 cases had residual lesion, including 2 cases of CINⅠ, 2 cases of CINⅡ, 5 cases of CIN Ⅲ, 2 cases of microinvasive carcinoma. The rate of residual lesions was 47.8%(11/23). Among the negative margins patients, 7 cases had residual lesion, including 4 cases of CINⅠ, 2 cases of CIN Ⅱ, 1 case of CIN Ⅲ. The rate of residual lesions was 9.0% (7/78). There was statistical difference in the rate of residual lesions between 2 groups (P<0.05). Conclusions The cervical biopsy under colposcopy has high risk of missing diagnosis of cervical cancer, thus it can not replace the diagnosis of cervical cold knife conization. There is still a certain percentage of residual lesions in the negative margins of cervical cold knife conization. The patients with recurrence or residual risk factors may be considered further surgical treatment.