改良式冷刀锥切术治疗宫颈上皮内瘤样病变Ⅱ、Ⅲ级172例疗效分析

目的:探讨改良式冷刀锥切术在治疗高级别宫颈上皮内瘤样病变中的价值。方法:对我院2007年1月～2009年12月接受宫颈锥切术的172例高级别宫颈上皮内瘤样病变患者的临床资料进行回顾性分析。根据手术方式分为两组,改良式冷刀锥切术为改良组,传统冷刀锥切术为对照组。比较两组的手术时间、术中出血量、切缘病理情况、术后宫颈狭窄或粘连发生率及宫颈鳞柱交界可见率等。结果:改良组平均手术时间及术中平均出血量明显少于对照组(P<0.05)。改良组与对照组切缘阳性率(5.6%、6.7%)、宫颈狭窄或粘连发生率(0、4.8%)差异均无统计学意义(P<0.05),而鳞柱交界可见率(93.2%、77.1%)差异有统计学意义(P<0.05)。结论:改良式冷刀锥切术,可以提供良好的锥切标本,并有效减少术中出血,缩短手术时间,同时具有术后宫颈鳞柱交界可见率高,有利于术后随访等优点,值得临床推广。

Improved cold-knife conization of cervical intraepithelial neoplasia in 172 cases

Objective. To investigate the effects of improved cold knife conization in the treatment of high-grade cervical intraepithelial neoplasia. Methods. Data of 172 patients with grade Ⅱ ,Ⅲ cervical intraepithelial neoplasia that underwent cold-knife conization during January 2007 and December 2009 were retrospectively analyzed. According to the surgical procedures, these patients were divided into conventional cold-knife conization group and improved cold knife conization group. Operative time, blood loss, positive rate of metastasis around the incision, postoperative incidence of cervical stenosis or adhesions and visibility of cervical squamous columnar junction were compared between the two groups. Results. The mean operative time and blood loss of the improved cold-knife conization group were significantly less than that of the control group （P〈0. 05）. Differences in the positive rate of metastasis around the incision （5.6% vs 6.7%）, and incidence of cervical stenosis or adhesions （0 vs 4.8%） between the two groups were not significant （P〉0.05）, while the visibility of squamous columnar junction （93.2% vs 77. 1%） was significant different （P〈0.05）. Conclusions. With less blood loss, and high visibility of squamous columnar junction, the improved cold knife conization can help to get proper specimens of cervical intraepi thelial neoplasia, and is worth for application in large scale.