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赵卫东 三甲
赵卫东 主任医师
安徽省立医院 妇产科

切缘阳性的CINIII级患者后继治疗的抉择

切缘阳性的CINIII级患者后继治疗的抉择


摘要  目的 探讨切缘阳性的宫颈上皮内瘤变Ⅲ级(CINⅢ)患者后继治疗方式的抉择,以及分析切缘阳性的影响因素对患者的重要作用。方法 比较78例非保守组与150例保守组宫颈内、外切缘阳性患者的组织病理学结果,同时,将保守组中切缘阳性患者的影响因素进行单因素和多因素分析。结果 ① 非保守组中,宫颈内外切缘阳性的患者发生残余率灶比较差异有统计学意义(P=0.015)。保守组中,宫颈外切缘阳性和宫颈内切缘阳性的患者复发率比较,差异有统计学意义(P=0.038)。非保守组与保守组,宫颈外切缘阳性与宫颈内切缘阳性患者复发率比较差异有统计学意义(P=0.037)。② 保守组中,单因素分析:是否绝经、宫颈外观,不同手术方式的切缘阳性率比较,差异均有统计学意义。结论 密切随访的宫颈外切缘阳性的CINⅢ患者可仅行宫颈锥切术绝经后、宫颈病变严重程度、宫颈环形电切术(LEEP)是宫颈切缘阳性的高危因素。中国科学技术大学附属第一医院(安徽省立医院)妇产科赵卫东

关键词  宫颈上皮内瘤变Ⅲ级;宫颈锥切术;切缘阳性

中图分类号 R 713.44

文献标志码 A 文章编号 1000-1492(2012)


The subsequent treatment of choice for CINIII patients with positive margins   

Abstract   Objective  To explore the subsequent treatment of choice for cervi-cal intraepithelial neoplasia grade III (CINIII) patients with positive margins, an-d analyze the important role of positive margin impact of factors on the patie-nts. Methods  Compared the cervical histopathologic findings of positive exoc-ervical margins and positive endocervical margins in the 78 cases of nonconser-vative treatment group and 150 cases of conservative treatment group. At the same time, patients with positive margins impact of factors analyzed by univariate a-nd multivariate logistic analyzes in conservative group. Results ① In nonconserv-ative treatment patients, Compared the residual disease rate of patients with positi-ve exocervical margins and positive endocervical margins, the differences were s-tatistically significant (P=0.015). In conservative treatment group, compared the r-elapse rate of patients with positive exocervical margins and positive endocervi-cal margins, the differences were statistically significant (P = 0.038). Compared th-e recurrence rate of two groups patients with positive exocervical margins and positive endocervical margins, the differences were statistically significant (P=0.037). ② In conservative group, compared positive margin rate of menopause, cer-vical appearance, different surgical methods, the differences were statistically sign-ificant . Conclusion  Conservative treatment could be safely used in patients with positive exocervical margins of close follow-up. menopause, cervical appea-rance, different surgical methods were positive margins highly relevant factors. Po-stmenopausal, the grade of serious cervical lesions, LEEP was high risk factor-s in patients with positive margins.

Key words   cervical intraepithelial neoplasia grade Ⅲ;cervix conization; positive margin


宫颈上皮内瘤变Ⅲ级(CINⅢ)患者应首选宫颈锥切术来明确诊断。而锥切后病理诊断仍为CINⅢ的病例,其后继治疗的抉择却是临床上非常困惑的问题。目前,鉴于对CINⅢ患者锥切后并发症和复发等因素的恐惧,很多病例选择了筋膜外子宫切除作为治疗手段。但是Kim 报道对于行宫颈锥切术后切缘阳性的CINⅢ患者可仅行宫颈锥切术。影响切缘阳性的影响因素很多,所以寻找导致宫颈锥切术后切缘阳性的影响因素对患者选择治疗方式和预后是临床医师一直关注的问题。而切缘为阳性的患者即使行追加子宫切除术,术后的复发率也并不能完全避免,阴道残端还可能有阴道上皮内瘤变(Vaginal intraepithelial neoplasia, VIN)的发生。该研究通过对宫颈锥切术后不同处理方式进行分析,为CINⅢ后续治疗提供依据。


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