宫颈冷刀锥切术和宫腔镜下宫颈锥切术治疗高级别宫颈上皮内瘤变的疗效分析

目的:比较宫颈冷刀锥切术(CKC)和宫腔镜下宫颈锥切术(TCRC)对于宫颈上皮内瘤变(CIN)Ⅱ、Ⅲ的临床疗效。方法:选取2010年1月1日至2014年6月1日就诊于南方医科大学珠江医院,手术、病理及随访资料完整的CINⅡ、Ⅲ患者共176例,其中CKC组62例,TCRC组114例。比较两组患者年龄、孕产次数及术前病理分级并评估手术时间、术中出血量、术后阴道流血及病理切缘阳性和术后宫颈狭窄、复发等情况。结果:两组患者年龄、孕产次数及术前CIN分级差异均无统计学意义(P0.05)。CKC组术中平均出血量(14.16±14.10 ml)、平均住院时间(5.73±1.43天)与TCRC组(29.80±20.55 ml,4.75±1.23天)比较差异有统计学意义(P0.05)。CKC组平均手术时间(33.15±11.42分钟)、术后阴道流血率(33.9%)、病理切缘阳性率(3.2%)、宫颈狭窄率(4.8%)、复发率(4.8%)与TCRC组(分别为33.18±14.61分钟、21.1%、5.3%、4.4%、3.5%)比较差异无统计学意义(P0.05)。CKC组术前宫颈活检病理和术后病理结果一致率为74.2%(46/62),TCRC组为72.8%(83/114),kappa值0.75。结论:两种方法用于治疗高级别宫颈上皮内瘤变均安全有效。与CKC相比,TCRC可减少患者住院时间,但可能增加术中出血量,需在手术中注意。     

改良Sturmdorf子宫颈锥切缝合术临床应用研究

目的探讨改良Sturmdorf宫颈锥切缝合术的临床应用价值。方法 2012年12月至2013年12月在中日友好医院妇产科对35例宫颈上皮内瘤变（CIN）宫颈锥切患者实施改良Sturmdorf缝合术（研究组）,观察其手术效果和并发症,并与31例行常规Sturmdorf缝合术的CIN患者（对照组）进行比较。结果研究组与对照组手术时间分别是（22.09±6.15）min和（26.45±10.66）min,术中出血量分别是（8.54±8.43）ml和（18.87±11.23）ml,两组手术时间和术中出血量比较,差异均有统计学意义（P〈0.05）。研究组术后出血率为0（0/35）,与对照组（3.13%,1/31）比较,差异无统计学意义（P〉0.05）。两组术后均无发热及宫颈狭窄发生。结论在宫颈锥切术中应用改良Sturmdorf缝合术比常规Sturmdorf缝合术可有效止血,操作简单,并发症少,值得临床推广应用。     

宫腔镜下宫颈锥切术和宫颈冷刀锥切术治疗绝经后女性宫颈上皮内瘤变的疗效分析

目的 探讨宫腔镜下宫颈锥切术(TCRC)和宫颈冷刀锥切术(CKC)治疗绝经后女性宫颈上皮内瘤变(CIN)的疗效。方法 选取四川省达州市中心医院2018年2月至2021年5月收治的78例绝经后CIN患者为研究对象,根据随机数表法分为TCRC组(n=41)和CKC组(n=37),比较两组的临床疗效,以及标本肿瘤转移抑制基因1(KAI1)、周期素依赖性激酶8(CDK8)的蛋白表达情况,并统计术后并发症。结果 TCRC组治愈率高于CKC组,复发率、标本切缘阳性率较CKC组显著降低(P <0.05);术后两组KAI1蛋白阳性率均升高,CDK8蛋白OD值均降低(P <0.05),但组间比较差异无统计学意义(P>0.05);两组并发症发生率比较差异无统计学意义(χ²=0.338,P=0.561)。结论 CKC及TCRC均能有效地改善KAI1、CDK8蛋白表达活性,且术后并发症风险低,相较于CKC,绝经后CIN患者应用TCRC治疗在促进术后恢复方面优势更显著。     

对比分析宫颈上皮内瘤变Ⅲ级治疗中宫颈环形电切术与宫颈冷刀锥切术的运用效果

目的研究对比分析宫颈上皮内瘤变Ⅲ级治疗中宫颈环形电切术与宫颈冷刀锥切术的运用效果。方法选取2018年2月~2019年3月我进行治疗的宫颈上皮内瘤变Ⅲ级患者102例,根据治疗手术方式不同可以分为对照组(51例)与研究组(51例),对照组患者采用宫颈冷刀锥切术(CKC),研究组患者采用宫颈环形电切术(LEEP)。比较两组患者术中出血量、手术时间、术后愈合时间。结果较对照组患者而言,研究组患者术中出血量明显较低(P<0.05),而且研究组患者的手术时间与术后愈合时间明显更短(P<0.05)。结论临床上使用中宫颈环形电切术与宫颈冷刀锥切术治疗宫颈上皮内瘤变Ⅲ级,两种手术治疗方式的效果具有一定的相似性,但是使用宫颈环形电切术进行治疗,患者治疗过程中承受的痛苦更少,该手术方式需要时间短,安全性较高,创伤小,术中出血量少,患者术后恢复更快,更有利于患者尽快恢复正常生活,在临床治疗中可以优先选择。     

宫颈冷刀锥切术诊治宫颈上皮内瘤变Ⅲ级320例临床分析

目的:探讨宫颈锥切术在宫颈上皮内瘤变Ⅲ级(CINⅢ)的诊断与治疗中的价值。方法:回顾性分析因宫颈CINⅢ行宫颈锥切术的患者320例,采用自身对照法,对比研究宫颈锥切术和阴道镜下活检的病理结果。结果:宫颈锥切术与阴道镜下检查的病理结果完全符合者187例(58.44%),不符合者133例(41.56%)。锥切术后病理诊断级别下降者69例(21.56%),漏诊微小浸润癌60例(Ⅰa1期55例,Ⅰa2期5例)(18.75%),漏诊浸润癌(Ⅰb1期)4例(1.25%)。59例患者再次行子宫切除术,其中32例(54.24%)术后病理转阴,16例病理诊断级别降低。宫颈锥切术的主要并发症是术后出血。结论:宫颈锥切术在CINⅢ的诊断和治疗中具有重要价值。应根据患者年龄、病变程度、切缘状态、生育要求等多方面个体化、综合考虑以决定进一步的治疗方案。     

子宫颈锥切术及根治性宫颈切除术术后妊娠问题

近年来国内外资料显示,宫颈上皮内瘤样病变(CIN)和宫颈癌患者有明显年轻化趋势。随着晚婚晚育的妇女越来越多,选择恰当的手术方式保留年轻宫颈宫颈上皮内瘤变(CIN)和宫颈癌患者的生育功能,以及术后妊娠结局是值得重视的问题。1子宫颈锥切术(conization of cervix)1.1适应证与术式宫颈锥切是治疗CIN常用的方法。锥切术的适应证主要为不能定期随访的CIN I,CIN II和CINIII和原位癌(CIS),既可诊断又可治疗,在年轻未育的原位癌患者有重要的治疗地位。微小浸润癌中如ⅠA1也可以考虑锥切术。传统的宫颈锥切术现统称为冷刀锥切(CKC),而…     

宫颈冷刀锥切术中3种止血方法的比较

目的:比较单纯压迫、电凝及缝合方法对宫颈冷刀锥切创面止血的效果.方法:5年来136例接受宫颈冷刀锥切的患者,按止血方法分为单纯压迫组(25例),电凝组(66例),缝合组(45例).比较术中出血量、手术时间及并发症等情况.结果:平均术中出血量单纯压迫组56.60±42.20 ml和电凝组63.33±46.15 ml,较缝合组98.67±72.22 ml明显减少(P<0.05).平均手术时间单纯压迫组23.40±11.43分钟显著短于电凝组33.53±17.89分钟和缝合组37.89±18.04分钟(P<0.05).手术相关并发症发生率单纯压迫组为24.00%,电凝组24.24%,缝合组28.89%(P0.05).结论:非缝合法对冷刀锥切术创面止血效果好、手术时间短,较缝合法有优势.     

宫颈上皮内瘤变锥切术后复发高危因素研究进展

宫颈上皮内瘤变(CIN)是浸润性宫颈癌的癌前病变,其发病率逐年增加。如不及时治疗,约66%CINⅡ、Ⅲ会进展为原位癌,2%进展为浸润癌。美国阴道镜宫颈病理学会(ASCCP)推荐对阴道镜检查满意的CINⅡ、Ⅲ采用可以保留生育功能的宫颈锥切术,其治疗失败率在1%～25%     

宫颈环形电切术与冷刀锥切术治疗宫颈上皮内瘤变疗效比较的Meta分析

目的:比较宫颈环形电切术(LEEP)与冷刀锥切术(CKC)治疗宫颈上皮内瘤变(CIN)的疗效.方法:通过计算机检索中国知网、维普、万方、PUBMED、EBSCO和Cochrane图书馆从1990年1月至2010年7月国内外公开发表的有关LEEP与CKC治疗CIN疗效比较的有关文献.按Cochrane系统评价方法,采用Revman 5.0进行Meta分析.结果:共纳入17项研究,2234例患者.Meta分析结果显示:LEEP与CKC相比,手术时间、术中出血量、愈合时间、住院天数、治疗费用和病灶切除的深度,差异均有统计学意义(P<0.05),而治愈率、复发率、持续存在率、残留率、术后出血、术后宫颈狭窄、手术切除的宽度及体积的比较,差异均无统计学意义(P>0.05).结论:LEEP治疗CIN的疗效与CKC相似,但LEEP具有手术时间短、术中出血量少、愈合时间快、住院天数少和治疗费用低的优点,值得临床推荐.     

Outpatient cervical conization

One hundred outpatient cervical conizations were performed over a 2.5-year period. A circumferential suturing technique was used which provided excellent hemostasis and restoration of normal cervical anatomy. The complication rate was low. One patient had significant intraoperative hemorrhage, one experienced postoperative bleeding within 24 hours, and two had delayed bleeding. Three patients developed infection, and one patient was found to have asymptomatic cervical stenosis on follow-up examination. No patient required blood transfusion or admission to the hospital. It is concluded that cervical conization can be performed on an outpatient basis in the nonpregnant patient with an acceptable rate of complications.     

The effect of cervical cerclage on pregnancy outcomes in women following conization

Abstract

Objectives: To determine the effect of cervical cerclage on obstetrical complications and perinatal outcomes of patients following conization.

Design: A retrospective population based cohort study.

Setting: Tertiary academic medical center that covers all the deliveries of the region.

Population: All patients with previous cervical conization who delivered between the years 1994–2011.

Methods: A retrospective population based study.

Main outcome measures: The effect of cerclage placement on the rate of preterm birth.

Results: During the study period there were 109 deliveries of patients following a cervical conization. Cervical cerclage was placed in 22 deliveries that served as the study group and the rest (n?=?87) served as the comparison group. The rate of early preterm delivery (PTD; <34 weeks) was significantly higher in women who had a cerclage. In a logistic regression model, cerclage was found to be an independent risk factor for early PTD.

Conclusion: Cerclage is an independent risk factor for early PTD In patients who had a conization due to CIN.     

Microcolpohysteroscopic tailoring of cervical conization

The ideal cone biopsy should have its apex just above the transformation zone to ensure removal of all abnormal squamous and metaplastic epithelium in the endocervix, with only minimal normal glandular tissue included. The microhysteroscope has been shown to be useful in identifying the upper limit of the transformation zone within the canal, and this distance from the external os can be measured. However, this technique has not been evaluated to determine whether it can tailor cone length to this predetermined measurement. We report an observational analysis of 176 consecutive conizations in patients with colposcopically proved extension of abnormal epithelium high into the cervical canal. In 162 cases, the distance of the transformation zone from the external os could be measured with the microhysteroscope and its endocervicometer, permitting an attempt to tailor the cone length to this measurement plus a safety margin of 5 mm. There was good correlation between the intended cone length and the excised cone length, with 85% of the excised cones falling within 5 mm above or below the intended measurement. In 153 instances (94.4%), the excised cones had clear endocervical margins. Thus, tailoring of the cone length to the hysteroscopically determined measurement is feasible, thereby increasing the chances of complete excision while limiting cone size to the required minimum.     

A comparison between CO2 laser conization and cold knife conization in clinical diagnosis of cervical intraepithelial neoplasia

Intraoperative and postoperative complications related to CO2 laser conization and cold knife conization were compared. From 1980 to 1984 66 patients were hospitalized for cold knife conization, the mean operative time was 28.1 minutes, all patients had epidural anesthesia, and the mean time of admission was 6.8 days. Three percent of cases had infections, the mean intraoperative hemorrhage was 75 ml, and the rate of remaining foci of neoplasia was 18.2%. Meanwhile there were 116 patients hospitalized for CO2 laser conization from 1985 to 1987. The mean operative time was 15.6 minutes, 15.5% of cases had local anesthesia, the mean time of admission was 0.6 days. Zero percent of cases had infections, 0% of cases had postoperative cervical stenosis, the mean intraoperative hemorrhage was 75 ml, and 29.5% of cases had remaining foci of neoplasia. There was no significant difference in hemorrhage amounts at hysterectomy following conization either method. Thus, in our experience, CO2 laser conization is more effective for clinical diagnosis and treating of cervical intraepithelial neoplasia.     

Obstetric outcome following cervical conization

Objective  

The purpose of the present study was to examine obstetric outcome of patients following conization and specifically the risk for preterm delivery (PTD).     

宫颈锥切术对妊娠结局的影响

目的 探讨宫颈冷刀锥切(cold knife conization,CKC)与环形电切术(loop electrical excision procedure,LEEP)对妊娠结局及分娩方式的影响。方法 采用回顾性病例对照研究,分析2004年1月至2010年1月在中山大学附属第一医院及广州市番禺区何贤纪念医院诊断为宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅱ～Ⅲ并接受宫颈锥切术治疗后的妊娠患者228例,其中行LEEP 168例、CKC 60例。按年龄、孕次、产次、经济收入相匹配的原则,1:1随机收集同期分娩的健康孕妇为对照组,观察各组的妊娠天数、胎膜早破(premature rupture of membranes,PROM)发生率、终止妊娠方式和新生儿出生体重。结果 病例组和对照组的妊娠天数分别为（268.3±26.2）d和(279.4±25.3)d,差异有统计学意义（t=4.60,P＜0.01）;早产率分别为18.0％ (41/228)和4.4％(10/228)(x2=21.22,P＜0.05);PROM发生率分别为10.1％(23/228)和1.3％(3/228)(x2=16.32,P＜0.05),病例组发生PROM的风险是对照组的8.42倍（OR=8.42,95％ CI：2.49～28.44）。2组剖宫产率分别为69.3％(158/228)和39.0％ (89/228),差异有统计学意义(x2=42.06,P＜0.05)。病例组中LEEP组与CKC组妊娠天数分别为(269.8±24.6)d和（260.2±26.5）d,差异有统计学意义(t=4.01,P＜0.01）;早产率分别为13.1％ (22/168)和31.6％ (19/60)(x2=10.34,P＜0.05)。新生儿出生体重分别为(3358.5±812.2)g和（3295.9±832.6）g,差异有统计学意义(t=3.08,P＜0.01);PROM发生率分别为7.1％ (12/168)和18.3％ (11/60),差异有统计学意义(x2=6.10,P＜0.05)。结论 宫颈锥切术增加了孕妇早产、PROM发生率;LEEP对妊娠结局的影响小于CKC。因此对有生育要求的患者,应优先考虑LEEP并告知相关风险。     

Development of endometrioma after cervical conization

The association between cervical conization and subsequent development of endometriosis is uncertain. The objective of this study was to estimate the incidence rate of ovarian endometrioma after cervical conization and to determine factors associated with the development of endometrioma. One hundred forty-two patients who underwent cervical conization at the University of Tokyo Hospital between January 2006 and December 2013 were included in the study. Their medical records were retrospectively studied until April 2015. The incidence rate of postconization endometrioma was calculated. Patients’ characteristics (age, parity, preoperative and postoperative diagnosis and observation period) were analyzed. Six patients developed endometrioma after the cervical conization, and the incidence rate of endometrioma among patients who underwent cervical conization was 10.8 per 1000 person-year (95%CI 3.6–20.5). Patients’ age, percent of nulliparous, postoperative diagnosis and observation period were not associated with the development of postconization endometrioma. A preoperative diagnosis with invasive cancer (p?相似文献   

宫颈锥形切除术诊治宫颈上皮内瘤变的临床价值(附303例报告)

目的:探讨宫颈锥形切除术诊治宫颈上皮内瘤变(CIN)的实用价值。方法:2005年2月～2007年12月经阴道镜多点活检病理检查诊断为CIN并实施宫颈LEEP术271例(LEEP组);CIN同期实施宫颈冷刀锥切术(CKC)32例(CKC组),随访治疗效果。结果:(1)LEEP组手术时间和术中出血量分别为9.3±5.1m in和14.4±13.8m l;CKC组为29.4±15.3m in和68.6±31.8m l,均高于LEEP组(P<0.01);(2)LEEP后宫颈病变级别升高23例(8.5%),完全符合131例(48.3%),降低117例(43.2%);CKC组分别为8例(25.0%)、20例(62.5%)、4例(12.5%);两组有显著差异(P<0.01);(3)LEEP组术后切缘阳性11例,病灶残留2例;切缘阴性260例,病灶残留3例;CKC组术后切缘阳性1例,无病灶残留;切缘阴性31例,病灶残留1例。各组子宫切除标本病理诊断级别再无升高病例;(4)随访期间LEEP组复发3例,余者无复发。LEEP组、CKC组治愈率分别为95.2%(139/146)、96.7%(29/30)。结论:LEEP治疗宫颈病变不仅可完整切除病灶,而且能消毁切缘病灶,消除宫颈HPV负荷,疗效肯定,简便易行。高级别CIN治疗前需要先行LEEP预处理,这对早期发现宫颈浸润癌有重要意义。