子宫颈锥切术在子宫颈上皮内瘤变诊断和治疗中的价值

目的 明确宫颈锥切术能否被阴道镜下多点活组织检查（活检）代替以及探讨宫颈锥切术在宫颈上皮内瘤变（CIN）诊断与治疗中的价值。方法 回顾性分析近5年来，因宫颈病变同时行宫颈细胞学检查、阴道镜下多点活检和宫颈锥切术的患者54例，采用自身对照法，对比研究宫颈锥切术和阴道镜下多点活检的病理检查结果。结果 宫颈锥切术与阴道镜下多点活检的病理检查结果完全符合者22例（40.7%)，不符合者32例（59.3%)。在因除外浸润癌而行宫颈锥切术的31例中，与阴道镜下多点活检的病理检查结果一致者仅13例（41.9%)。宫颈锥切术后，因发现早期浸润部，行广泛子宫切除术者2例（3.7%)；因CINⅢ级（CINⅢ）或微小逮润癌行全子宫切除术者13例（24.1%)。39例（73.2%)患者宫颈锥切术后密切随诊，保留了生育功能，在平均为18.3个月的随诊期内，无一例出现宫颈细胞学检查异常，其中3例妊娠并已分娩，宫颈锥切术主要的并发症是术后出血。结论 宫颈锥切术在CIN治疗中具有举足轻重的重要价值。它不能被阴道镜下多点活检所取代，对于患者CINⅢ又要保留生育功能的年轻患者，宫颈锥切术是较为适当的治疗方法。

Evaluation of cervical conization diagnosis and management of cervical intraepil neoplasia

OBJECTIVE: To determine whether cervical conization can be instead of colposcopic multiple biopsies and to evaluate the clinical value of cervical conization in diagnosis and management of cervical intraepithelial neoplasia. METHODS: Fifty four patients with cervical intraepithelial neoplasia (CIN) diagnosed and treated at Peking Union Medical College hospital were retrospectively analyzed focusing on the comparative study in pathology between cerical conization and colposcopic multiple biopsies. RESULTS: Of the 54 patients, there was a correlation in pathology between cervical conization and colposcopic multiple biopsies in 22 cases (40.7%), but there was not much correspondence between cervical conization and colposcopic multiple biopsies in 32 cases (59.3%). In 31 cases conization performed for ruling out invasive cancer, there was a correlation in pathology between cervical conization and colposcopic multiple biopsies in only 13 cases (41.9%). After conization radical hysterectomy was performed in 2 cases (3.7%) because of early invasive carcinoma and simple hysterectomy was performed in 13 cases (24.1%) because of CINIII involved the gland and microinvasive carcinoma of the cervix. 39 cases (73.2%) were closely followed-up postoperatively with preservation of fertility. During the mean follow-up time of 18.3 months, no cytology abnormality was detected and 3 patients had pregnancy and delivery. Postoperative hemorrhage was main side effect for conization. CONCLUSIONS: Cervical conization plays a very important role in diagnosis and treatment of CIN and it can not be instead of colposcopic multiple biopsies. Cervical conization is a good choice for patient with CINIII and desired childbearing.