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[目的]探讨宫腔镜下电凝止血辅助宫颈冷刀锥切术以及术后局部应用纳米银凝胶和宫颈导管在宫颈上皮内瘤变(CIN)诊断与治疗中的价值。[方法]追踪随访分析2005年1月～2008年12月,因宫颈上皮内瘤变行宫腔镜辅助宫颈冷刀锥切术的患者204例,统计术中出血量、手术时间、病理结果及术后并发症,定期随访行细胞学检查和HPV检测,必要时行阴道镜下活检。[结果]平均手术时间(26.3±3.6)min,平均出血量(22.8±12.3)ml。冷刀锥切术后与阴道镜下多点活检病理诊断完全相符者110例,占53.9%,不符者94例,占46.1%。其中有49例(24%)病理级别下降,45例(22.1%)病理级别上升。术后无1例发生大出血,亦无颈管粘连及狭窄;术后3个月复查未出现细胞学检查异常;HPV均逐渐转阴。[结论]宫颈冷刀锥切术在CIN诊断及治疗中具有重要作用,宫腔镜下电凝止血辅助宫颈冷刀锥切术是CIN较为理想的治疗方法,局部应用纳米银凝胶及宫颈导管可有效预防并发症的发生。
[Objective] To explore the value of hysteroscopic electrocoagulation and hemostasis assisted with cervical cold knife conization and the application of nano-silver gel and cervical catheter in the diagnosis and treatment of cervical intraepithelial neoplasia (CIN). [Methods] Follow-up Follow-up Analysis From January 2005 to December 2008, 204 patients with cervical intraepithelial neoplasia underwent hysteroscopy assisted with cold knife conization, and the blood loss, operation time, pathology and operation Postoperative complications, regular follow-up cytology and HPV testing, if necessary colposcopic biopsy. [Results] The average operation time (26.3 ± 3.6) min, average bleeding volume (22.8 ± 12.3) ml. After cold knife conization and colposcopy biopsy exactly the same pathological diagnosis of 110 cases, accounting for 53.9%, 94 cases, accounting for 46.1%. Among them, 49 cases (24%) reduced the pathological grade and 45 cases (22.1%) increased their pathological grades. No postoperative hemorrhage occurred in 1 case and no adhesions and stenosis of the cervical canal. No cytologic abnormalities occurred after 3 months of reoperation. HPV gradually turned negative. [Conclusions] Cervical cold knife conization has an important role in the diagnosis and treatment of CIN. Hysteroscopic coagulation-assisted cervical cold knife conization is an ideal treatment for CIN. Local application of nano silver gel and cervical catheter Can effectively prevent the occurrence of complications.