摘要
目的探讨因官颈上皮内瘤变(cervical intraepithelial neoplasm,CIN)行锥切术后病理切缘阳性患者的进一步处理。方法对1990年1月至2005年9月因CIN在北京协和医院行宫颈锥切术675例患者的病历,详细分析其中术后病理切缘阳性的72例患者的处理情况。结果宫颈锥切术后病理标本切缘阳性发生率为10.7%(72/675)。72例中保留子宫定期随诊21例(29.2%),进一步治疗51例(70.8%)。CINⅠ2例,CINⅡ3例均随诊无复发;CINⅢ37例,术后随诊14例,其中1例发展为浸润癌,1例发现低度上皮内瘤样病变,病变持续或进展的发生率为14.3%(2/14),进一步手术治疗23例;微小浸润癌11例,1例切缘病变为CINⅢ随诊无复发,余10例手术治疗;浸润癌16例,1例随诊且进展。结论宫颈锥切病理标本切缘为CINⅠ～CINⅢ阳性的患者可以进行术后随访,但内外切缘均有CINⅢ的患者,复发可能性大。微小浸润癌切缘为CINⅢ及以下病变的患者可行全子宫切除术,但切缘仍有微小浸润癌灶应行再锥切或按Ⅰb期处理。宫颈锥切后诊断为浸润癌者均应按浸润癌行规范化治疗。
Objective： To discuss the following treatment for the patients with positive margins after conization of cervical intraepithelial neoplasm （CIN）. Methods： The medical records of 675 cases of CIN treated with cervical eonization at Peking Union Medical College Hospital from January 1900 to September 2005 were retrospectively studied, with the analysis of the treatments for 72 cases with positive margins in details. Results： Seventy-two （10.7%） cervical conization specimens had positive margins. Of the 72 patients with positive margins, 21 cases （29.2%） had the uterus preserved and were followed up closely, and 51 cases （70. 8%） underwent further treatment. 2 cases of CIN Ⅰ and 3 cases of CINⅡ were followed up and didnrt relapse. Among 37 cases of CINⅢ, 14 advanced to invasive carcinoma and 1 became low cases were followed up. Of those followed up, 1 case grade squamous intraepithelial lesion. The rate of disease persistence or relapse or development to invasive carcinoma was 14. 3%. 23 cases of CINⅢ received a further operation. In 11 cases of microinvasive carcinoma, 1 patient with margin CINⅢ was followed upand the other 10 received advanced operation. 1 of 16 followed up and found to be deteriorated. patients with invasive cervical carcinoma margins was Conclusions： For the positive margins after cervical conization, we could follow up the patients carefully for CIN Ⅱ - Ⅲ residual diseases, but if the ectocervical and the endocervical margins are all positive with CINⅢ , it is more likely to relapse. For cervical microinvasive carcinoma with CINⅢ margin positive, hysterectomy should be considered. In presence of microinvasive margin, it is considered to reconizate or treat it according to the guide for stage Ⅰb cervical carcinoma. After cervical conization, patients with invasive cervical carcinoma margins should be treated systematically as advanced diseases.
出处
《生殖医学杂志》
CAS
2010年第2期112-115,共4页
Journal of Reproductive Medicine
关键词
宫颈上皮内瘤变
宫颈锥切
切缘阳性
治疗
Cervical intraepithelial neoplasm
Cervical conization
Positive margins
Treatment
