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【目的】探讨CIN锥切术后切缘阳性或高级别宫颈上皮内瘤样病变(CIN)病人的处理方法。【方法】回顾性分析2004年5月至2005年12月28例CIN普通电刀锥切术后再治疗的临床资料,并将锥切术后的病理与进一步治疗后病理进行分析比较。28例锥切病人中切缘阳性者10例,切缘阴性者18例。再治疗者采用子宫切除术26例(92.86%),宫颈锥切2例。【结果】全组再次术后标本中无病变者16例(57.15%),降级者7例(25.0%),相符者5例(17.85%)。锥切切缘阳性和阴性再次术后的宫颈残存病灶分别为60%(6/10)和33.33%(6/18),两者差异无显著性。锥切术后病理中3例浸润癌(1例腺癌,2例鳞癌),再次术后变为1例阴性,1例降级,1例腺癌深肌层浸润。锥切术后病理中发现5例微小浸润癌,再次术后2例降级,2例转阴,1例相符。20例高级别CIN(6例CIN 2~3级、14例CIN 3级)术后15%相符,20%降级,65%转阴。【结论】CIN锥切术后为浸润癌者,必须及时处理。术后为微小浸润癌和高级别的CIN、切缘阳性者,根据具体情况进一步处理。
【Objective】 To investigate the treatment of patients with positive or high-grade cervical intraepithelial neoplasia (CIN) after CIN conization. 【Methods】 The clinical data of 28 cases of CIN general electric knife conization after re-treatment from May 2004 to December 2005 were retrospectively analyzed. The pathological changes after conization and the pathology after further treatment were analyzed and compared. 28 cases of conization in patients with positive margins in 10 cases, negative margins in 18 cases. Re-treatment of hysterectomy in 26 cases (92.86%), 2 cases of cervical conization. 【Results】 There were 16 cases (57.15%) with no lesions in the whole group and 7 cases (25.0%) with degraded. Conization cut margin positive and negative residual reocclusion of cervical lesions were 60% (6/10) and 33.33% (6/18), the difference was insignificant. Three cases of invasive carcinoma (1 case of adenocarcinoma and 2 cases of squamous cell carcinoma) after conization were found to be negative, 1 case of degeneration and 1 case of deep myometrial invasion. Conectomy pathology found in 5 cases of micro-invasive carcinoma, again after the downgrade in 2 cases, 2 cases turned negative, 1 case match. 20 cases of high-grade CIN (6 cases of CIN 2 ~ 3, 14 cases of CIN 3) after 15% consistent, 20% degenerated, 65% negative. 【Conclusions】 CIN is invasive carcinoma after conization, and must be treated in time. Postoperative microinvasive cancer and high-grade CIN, positive margins, according to the specific circumstances of further processing.