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目的:明确阴道镜下多点活检不能代替宫颈锥切术作为治疗宫颈上皮内瘤变(CIN)前的最终诊断,探讨宫颈冷刀锥切术(CKC)在CINⅢ治疗中的应用价值。方法:回顾性分析76例因CINⅢ同时行阴道镜下多点活检和CKC的患者资料,采用自身对照法,对比研究CKC和阴道镜下多点活检的病理结果,并对治疗效果进行综合评价。结果:病理结果完全符合者占56.6%(43/76),术后病理诊断级别下降占28.9%(22/76),术后病理诊断级别上升占14.5%(11/76),HPV感染率为63.2%。9例浸润癌患者中有6例阴道镜下多点活检同时伴有腺体受累(66.7%),11例原位癌中有1例伴有腺体受累(9.1%),二者相比差异有统计学意义。CKC术后病理检查对进一步治疗起决定性作用,14例原位癌及浸润癌患者再次手术扩大治疗范围,仅行锥切术的62例患者术后无一例发生严重并发症。结论:CKC在CIN的诊断中占有重要地位,不能被阴道镜下多点活检所代替;CKC是治疗CINⅢ较为理想和安全的手术方式,术后应注意病理观察,密切随诊。
Objective: To clarify the multi-point biopsy under colposcopy can not replace cervical conization as a final diagnosis before treatment of cervical intraepithelial neoplasia (CIN), to explore the application of cervical cold knife conization (CKC) in CIN Ⅲ treatment. Methods: A retrospective analysis of 76 cases of CIN Ⅲ by colposcopy multi-point biopsy and CKC patients, using self-control method, comparative study of CKC and colposcopy biopsy pathological results, and the comprehensive evaluation of the treatment effect. Results: The pathological findings were completely consistent (56.6%, 43/76), the postoperative pathological diagnosis level was decreased (28.9%), the postoperative pathological diagnosis level was 14.5% (11/76), the HPV infection rate was 63.2%. Among the 9 patients with invasive carcinoma, 6 underwent colposcopic multipoint biopsy accompanied with glandular involvement (66.7%) and 1 out of 11 carcinoma in situ with glandular involvement (9.1%), the differences between the two There is statistical significance. CKC postoperative pathological examination for further treatment play a decisive role in 14 cases of carcinoma of the carcinoma in situ and invasive reoperation to expand the scope of treatment, only 62 patients underwent conization in no case of serious complications. Conclusion: CKC plays an important role in the diagnosis of CIN and can not be replaced by colposcopy multi-point biopsy. CKC is an ideal and safe surgical treatment for CINⅢ. Postoperative pathological observation should be paid attention and follow-up should be followed closely.