CIN宫颈锥切术后病变残留临床处理

目的:探讨引起宫颈上皮内瘤变宫颈锥切术后病变残留的因素及处理。方法:2007年1月～2009年6月在我院因CIN行宫颈锥切手术的患者中切缘残留20例,无切缘残留121例。分析CIN锥切术后病变残留与切缘阳性、病变程度,以及是否专科手术者的关系。结果:141例中切缘残留20例(14.1%),重度宫颈糜烂研究组16例(80%),对照组无切缘残留121例,重度宫颈糜烂13例(10.7%)。141例宫颈锥切患者,由普通医生实施手术操作的54例,切缘阳性13例,切缘阳性率24%;由专科医生实施手术操作的87例,切缘阳性7例,切缘阳性率为8%。结论:宫颈锥切术后病变残留应行HPVDNA检测和阴道镜随诊,来确定是否行二次锥切术。

Clinical treatment on residues after CIN conization

Objectives： To explore on the factors and clinical treatment of residues after CIN conization surgery. Methods： We studied 20 patients with excision margin residues and 121 patients without excision margin residues who have received CIN eonization surgery in our hospital between January 2007 and December, 2009, to understand the relationship between CIN eonization residues and positive excision margins, degree of pathological changes and expertise of the surgeon. Results： Among 141 studied cases, 20 cases showed excision margin residues（ 14. 1% ） of which 15 cases having severe cervical erosion （32%）, while 121 cases indicated no margin residues of which 42 cases having severe cervical erosion （ 15.2% ）. General surgeon performed 54 conization among the 141 cases. There are 13 cases of positive excision margin, the rate being 24%. Specialized surgeon performed 87 cases of conization, with 7 cases of positive excision margin （8%）. Conclusion： CIN conization residues should be detected with HPV DNA and vaginoscopy to determine whether the secondary conization is necessary.