【摘要】 目的:探讨普通电刀与冷刀宫颈锥切术(cold-knife conization,CKC)在宫颈上皮内瘤变(cervical intraepithelial neo-plasia,CIN)和微小浸润癌诊治中的临床应用价值。方法:回顾性分析2005年1月～2006年12月间因阴道镜下活检病理诊断为CINⅢ/子宫颈原位癌(carcinoma in situ,CIS)或不除外宫颈癌早期浸润的236例患者的临床资料,其中接受普通电刀宫颈锥切术患者107例(电刀组),接受冷刀宫颈锥切术患者129例(冷刀组)。对两组手术时间、手术出血量及术后并发症进行比较;电刀组中36例及冷刀组中15例锥切后行全子宫切除术或根治性手术的后续治疗,将两组的子宫标本与宫颈锥切标本进行病理比较;电刀组的71例和冷刀组的114例进行了术后的随访,对两组术后3个月、6个月、9个月及24个月复诊的痊愈率、病变持续存在率/复发率进行比较。结果:①手术时间:电刀组(25.55±8.25)min,比冷刀组(29.52±8.96)min短(P=0.001);术中出血:电刀组(14.52±10.78)ml,较冷刀组(26.07±13.40)ml少(P=0.00);电刀组术后并发症发生率(6.54%)较冷刀组(14.73%)低(P<0.05);②切除的子宫标本中,≥CINⅡ的病变残留,两组比较无统计学差异(P=1.00);两组宫颈锥切切缘阳性率比较无统计学差异(P=1.00)。③累计随访异常率:电刀组为7.75%(5/71),冷刀组为10.53%(12/114),两组比较无统计学差异(P=0.43);两组在3个月、6个月、9个月、均值为24个月随诊的痊愈率、病变持续存在率/复发率,电刀治疗组优于冷刀治疗组,但无统计学差异(P>0.05)。结论:应用普通电刀施行宫颈锥切术在手术时间、术中出血及术后并发症方面优于冷刀锥切术,诊治CINⅢ和微小浸润癌临床疗效与冷刀锥切相似,应得到临床的重视和应用。更多还原

【Abstract】 Objective:To explore the clinical application values of general electrosurgical conization and cold-knife conization(CKC) in diagnosis and treatment of cervical intraepithelial neoplasia(CIN) Ⅲ and microinvasive carcinoma.Methods:The clinical data of 236 cases diagnosed as CIN Ⅲ/carcinoma in situ(CIS) or early invasive ovarian carcinoma by biopsy and pathological examination under colposcope from January 2005 to December 2006 were analyzed retrospectively,107 cases received general electrosurgical conization(general electrosurgical conization group) and 129 cases received CKC(CKC group).The operation times,the amounts of blood loss during operation and postoperative complications in the two groups were compared;36 cases in general electrosurgical conization group and 15 cases in CKC group received subsequent treatment such as total hysterectomy and radical surgery,the pathological results of uterine samples and resected cervical samples in the two groups were compared;71 cases in general electrosurgical conization group and 114 cases in CKC group were followed up after operation;the curative rates and the ratios of exist rate/recurrence rate in the two groups at 3,6,9 and 24 months after operation were compared.Results:The operation time in general electrosurgical conization group was(25.55±8.25) minutes,which was shorter than that in CKC group((29.52±8.96) minutes)(P=0.001);the amount of blood loss during operation in general electrosurgical conization group was(14.52±10.78) ml,which was lower than that in CKC group((26.07±13.40) ml)(P=0.00);the incidence of complications after operation in general electrosurgical conization group was 6.54%,which was lower than that in CKC group(14.73%)(P<0.05).There was no significant difference in residual lesion(≥CINⅡ) in resected uterine samples between the two groups(P=1.00);there was no significant difference in positive rate of cervical margin between the two groups(P=1.00);the accumulative abnormal rate of follow-up in general electrosurgical conization group and CKC group were 7.75%(5/71) and 10.53%(12/114),respectively,there was no significant difference between the two groups(P=0.43);the curative rates and the ratios of exist rate/recurrence rate in general electrosurgical conization group at 3,6,9 and 24 months after operation were superior to those in CKC group,but there was no significant difference(P>0.05).Conclusion:The operation time,the amount of blood loss during operation and the incidence of complications after operation of general electrosurgical conization are superior to those of CKC,and the clinical efficacies of the two methods are similar,which should be paid more attentions to in clinical application.更多还原