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目的:探讨应用普通电刀的宫颈锥切术诊治宫颈上皮内瘤变(CIN)和微小浸润癌的临床效果。方法:选择2012年1月至2014年1月在我院接受普通电刀的宫颈锥切术患者55例,对手术时间、术中出血量进行记录,同时对术后病灶残留、手术前后病理符合情况以及再次手术情况进行分析。结果:手术中位时间为35分钟,术中出血量为50ml。全部55例患者中,锥切标本的病理诊断和术前阴道镜下活检结果相同的患者49例,手术前后的病理符合率为89.09%,其余患者锥切术后的病理诊断和术前相比成升级或者降级。术前诊断为CIN的患者共52例,其中发现微小浸润癌IA1期1例,在术前诊断为微小浸润癌IA1期的患者2例,其中1例患者间质浸润深度超过微小浸润癌范围而被误诊为早期浸润癌IB1期。最后诊断为IA1期的2例患者中,1例患者为切缘阳性再次给予锥切术,另外有1例患者给予次广泛全子宫切除术。在最后诊断为CIN的51例患者中,切缘阳性患者2例,其中1例患者补充行全子宫切除术。1例患者术前活检阴性患者术后证实为浸润型腺癌,另外有1例CIN患者合并原位腺癌,术后全部给予再次手术。结论:在对CIN和微小浸润癌进行诊断和治疗时,普通电刀的宫颈锥切术是一种操作简单、术中出血量少、手术时间不长,同时具有较高切净率的方法。普通电刀的宫颈锥切术在诊断宫颈微小浸润癌、腺癌以及局部早期浸润癌时准确率非常高。在锥切术后,如果患者为切缘阳性或者早期浸润癌,则需根据患者实际情况进行再次处理。
Objective: To investigate the clinical effect of cervical cone incision in diagnosis and treatment of cervical intraepithelial neoplasia (CIN) and micro-invasive carcinoma using common electric knife. Methods: From January 2012 to January 2014, 55 cases of cervical cone conization undergoing general electric knife in our hospital were selected. The operation time and intraoperative blood loss were recorded. At the same time, the pathological changes were observed after operation Situation and re-operation analysis. Results: The median operation time was 35 minutes, the amount of bleeding during surgery was 50ml. In all 55 cases, the pathological diagnosis of conical specimens was the same as preoperative biopsy in 49 cases, the pathological coincidence rate was 89.09% before and after operation. The pathological diagnosis of the other patients after conization was compared with that before operation To upgrade or downgrade. Preoperative diagnosis of CIN in patients with a total of 52 cases, which found a small invasive carcinoma in IA1 stage, preoperative diagnosis of minimal invasive cancer in patients with IA1 in 2 cases, 1 case of patients with interstitial infiltration depth beyond the scope of micro-invasive cancer Was misdiagnosed as early invasive cancer IB1 period. Of the 2 patients who were finally diagnosed as stage IA1, one patient was positive for conization again with conization, and one patient was given subtotal hysterectomy. Of the 51 patients who were finally diagnosed with CIN, 2 were positive margins, and 1 of them had a hysterectomy. One patient with negative biopsy before operation was confirmed as invasive adenocarcinoma. Another patient with CIN was treated with adenocarcinoma in situ. All patients underwent reoperation after operation. Conclusion: In the diagnosis and treatment of CIN and microinvasive carcinoma, cervical cone conization of ordinary electric knife is a simple operation, less bleeding during operation, less operation time and high rate of clean-up. Cervical conization of the common electric knife in the diagnosis of cervical micro-invasive carcinoma, adenocarcinoma and local early invasive carcinoma when the accuracy is very high. After conization, patients with positive margins or early invasive cancers should be re-treated according to the patient’s condition.