中外医疗
中外醫療
중외의료
CHINA FOREIGN MEDICAL TREATMENT
2014年
12期
21-23
,共3页
子宫颈上皮内瘤变%锥切术%切缘阳性
子宮頸上皮內瘤變%錐切術%切緣暘性
자궁경상피내류변%추절술%절연양성
Cervical intraepithelial neoplasia%Conization%Positive margin
目的：探讨子宫颈高级别上皮内瘤变锥切术后切缘阳性的处理及预后，总结治疗经验。方法以子宫颈高级别上皮内瘤变患者锥切术后切缘阳性再行手术治疗的228例作为研究对象，根据第2次术后病理结果将研究对象分为病变残留和无残留两组，对两组患者相关因素进行比较分析。结果病变无残留者133例，占58.33%，残留者95例，占41.67%，两组患者年龄差异无统计学意义（P＞0.05），首次手术方式、病变级别、阳性切缘病变级别、阳性切缘部位、HPV差异有统计学意义（P＜0.05）。结论术前HPV高拷贝、病变级别高、特别是原位癌、阳性切缘位于颈管端的患者病变残留高风险，需行再次锥切或严密随访。切缘部位为原位癌者建议扩大子宫切除。具体治疗方案需结合患者意愿、生育要求、随访条件而定。
目的：探討子宮頸高級彆上皮內瘤變錐切術後切緣暘性的處理及預後，總結治療經驗。方法以子宮頸高級彆上皮內瘤變患者錐切術後切緣暘性再行手術治療的228例作為研究對象，根據第2次術後病理結果將研究對象分為病變殘留和無殘留兩組，對兩組患者相關因素進行比較分析。結果病變無殘留者133例，佔58.33%，殘留者95例，佔41.67%，兩組患者年齡差異無統計學意義（P＞0.05），首次手術方式、病變級彆、暘性切緣病變級彆、暘性切緣部位、HPV差異有統計學意義（P＜0.05）。結論術前HPV高拷貝、病變級彆高、特彆是原位癌、暘性切緣位于頸管耑的患者病變殘留高風險，需行再次錐切或嚴密隨訪。切緣部位為原位癌者建議擴大子宮切除。具體治療方案需結閤患者意願、生育要求、隨訪條件而定。
목적：탐토자궁경고급별상피내류변추절술후절연양성적처리급예후，총결치료경험。방법이자궁경고급별상피내류변환자추절술후절연양성재행수술치료적228례작위연구대상，근거제2차술후병리결과장연구대상분위병변잔류화무잔류량조，대량조환자상관인소진행비교분석。결과병변무잔류자133례，점58.33%，잔류자95례，점41.67%，량조환자년령차이무통계학의의（P＞0.05），수차수술방식、병변급별、양성절연병변급별、양성절연부위、HPV차이유통계학의의（P＜0.05）。결론술전HPV고고패、병변급별고、특별시원위암、양성절연위우경관단적환자병변잔류고풍험，수행재차추절혹엄밀수방。절연부위위원위암자건의확대자궁절제。구체치료방안수결합환자의원、생육요구、수방조건이정。
Objective To investigate the treatment of positive margin for patients with cervical intraepithelial neoplasia after conization and the prognosis, and summarize the experience of treatment. Methods 228 cases of cervical intraepithelial neoplasia patients with positive margin after conization underwent surgical treatment for the second time were selected as the subjects. Based on the second postoperative pathology results, the subjects were divided into two groups of residual lesions and no residue, and the related factors of two groups of patients were compared and analyzed. Results The lesions without residual in 133 cases, accounting for 58.33%, residual in 95 cases, accounting for 41.67%; the difference between two groups in age was not statistical-ly significant (P>0.05), but the differences between the groups in the first mode of operation, pathological grade, positive margin lesion grade, positive margin part, and HPV were statistically significant (P<0.05). Conclusion Preoperative HPV high copy, high grade lesions, especially carcinoma in situ, positive margins in the neck tube end of the lesions in patients with residual high risk, need the second conization or close follow-up. Expanding uterus excision is suggested for the patients whose cutting edge part is carcinoma in situ. The specific treatment should be combined with the patient's wish, fertility requirements and follow-up conditions.
