宫颈锥形切除术诊治宫颈上皮内瘤变临床观察

目的分析宫颈锥形切除术在宫颈上皮内瘤变(CIN)诊断与治疗中的临床价值。方法回顾分析128例经阴道镜活检病理检查诊断为CIN行宫颈锥切术治疗的临床资料,其中实施宫颈电热圈环形切除术(LEEP)108例(LEEP组);同期实施宫颈冷刀锥切术(CKC)20例(CKC组)。采用对照法,对比研究宫颈锥切术和阴道镜下活检的病理结果,术后HPV消退情况,并结合有关文献进行分析讨论。结果 128例患者术前阴道镜下宫颈活检病理结果与LEEP组比较,二者诊断完全符合74例,占68.51%;术后病理比术前CIN等级升高者15例,占13.89%,术后病理比术前CIN等级下降者19例,占17.59%;CKC组分别为14例(70%)、1例(5.0%)、5例(40%)。术后病理提示LEEP组切缘阳性6例,切缘阴性102例;CKC组术后切缘阳性1例,切缘阴性19例,各组子宫切除标本病理诊断级别再无升高病例。LEEP组、CKC组治愈率分别为94.4%(102/108)、95.0%(19/20)。术前高危型HPV阳性共101例,术后3个月复查HPV转阴86例,15例术后阳性随访3~12月,定期检查无病变发现。所有患者术后随访期间无复发。结论宫颈锥切术在CIN的诊断和治疗中具有双重价值。不仅可完整切除病灶,而且能消毁切缘病灶,对消除宫颈HPV感染作用明显,疗效肯定,简便易行,是一种理想的治疗方法。

Cervical conization in diagnosis and treatment of cervical intraepithelial neoplasia and clinical observation of 128 cases

Objective To analyse the clinical value of performing conization in diagnosis and treatment of cervical intraepithelial neoplasia （ CIN）. Methods 128 cases of colposcopic biopsy for the diagnosis of CIN after performing conization were retrospective analyzed. 108 cases of CIN who were performed LEEP as LEEP group,20 cases of CIN who w ere performed cold knife conization in themean time as CKC group. And were retrospectively analyzed and comparative study the pathology results between cervical conization and colposcopie multiple biopsies. Resolution of HPV,combined with the relevant literature and discuss. Results There was a correlation in pathology cervical eonization and vaginoscope mul-tiple biopsies in 74 cases（68. 51%）. 15 cases of postoperative pathology than preoperative CIN level elevated,accounted for 13. 89%. 19 cases of postoperative pathology decreased CIN level before operation,17. 59%. CKC group were 14 cases（70%）,1 cases（5%）,5 cases（40%）. Pathological results showed LEEP positive margin in 6 cases;102 cases with negative surgical margins. Margin after operation in CKC group was positive in 1 cases,19 cases with negative surgical margins. The hysterectomy specimen pathology diagnosis level no higher case. LEEP group, CKC group,the cure rate was 94. 4%（102/108）,95%（19/20）. Preoperative high-risk HPV positive were 101 cases,86 cases of HPV nega-tive three months after operation,15 cases were followed up for 3-12 months,regularly check no lesions found. No recurrence after operation in all patients during the follow-up period. Conclusion Cervical conization has double value in the diagnosis and treatment of CIN. Not only can complete excision of the lesion,and can destroy the margin of lesions,the elimination of cervical HPV infection effect,Curative effect,conven-ient,is an ideal treatment method.