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目的:探讨宫颈锥切术在宫颈上皮内瘤变Ⅲ级(CINⅢ)的诊断与治疗中的价值。方法:回顾性分析因宫颈CINⅢ行宫颈锥切术的患者320例,采用自身对照法,对比研究宫颈锥切术和阴道镜下活检的病理结果。结果:宫颈锥切术与阴道镜下检查的病理结果完全符合者187例(58.44%),不符合者133例(41.56%)。锥切术后病理诊断级别下降者69例(21.56%),漏诊微小浸润癌60例(Ⅰa1期55例,Ⅰa2期5例)(18.75%),漏诊浸润癌(Ⅰb1期)4例(1.25%)。59例患者再次行子宫切除术,其中32例(54.24%)术后病理转阴,16例病理诊断级别降低。宫颈锥切术的主要并发症是术后出血。结论:宫颈锥切术在CINⅢ的诊断和治疗中具有重要价值。应根据患者年龄、病变程度、切缘状态、生育要求等多方面个体化、综合考虑以决定进一步的治疗方案。
Objective: To investigate the value of cervical conization in the diagnosis and treatment of cervical intraepithelial neoplasia grade Ⅲ (CIN Ⅲ). Methods: A retrospective analysis of 320 cases of cervical conization due to cervical CIN Ⅲ cervical conization, self-control method, comparative study of cervical conization and colposcopy biopsy pathology results. Results: Cervical conization and colposcopy were completely consistent with the pathological findings in 187 cases (58.44%), 133 cases (41.56%) did not meet. There were 69 cases (21.56%) with pathological diagnosis of conization, 60 cases of missed invasive carcinoma (55 cases of stage Ⅰa and 5 cases of stage Ⅰa2), 4 cases (1.25%) of missed invasive carcinoma (stage Ⅰ b1) ). Fifty-nine patients underwent hysterectomy again. Among them, 32 cases (54.24%) were negative after surgery and 16 cases were diagnosed as pathological changes. Cervical conization is the main complication of postoperative bleeding. Conclusion: Conization of the cervix in the diagnosis and treatment of CIN Ⅲ has important value. Should be based on the patient’s age, degree of lesion, cut edge status, reproductive requirements and other aspects of individual, comprehensive consideration to decide on further treatment options.