目的 分析宫颈上皮内瘤变(CIN)Ⅲ级患者宫颈冷刀锥切术后再行子宫全切术各病理结果,探讨其宫颈冷刀锥切术后进一步处理方式.方法 回顾性分析140例CINⅢ患者的临床资料,均为宫颈冷刀锥切术后再次行全子宫切除术的患者.结果 140例患者中,102例(72.9%)患者的阴道镜下宫颈活检及宫颈冷刀锥切术后病理结果相符,18例(12.9%)病理降级,20例(14.3%)病理升级,其中5例升级为浸润癌.宫颈冷刀锥切术后切缘阳性32例,切缘阴性108例.切缘阳性患者中,全切术后病理提示15例病灶残留,其中CINⅠ5例,CINⅡ3例,CINⅢ6例,宫颈癌IA1期1例,病灶残存率46.9%;切缘阴性患者中,全切术后病理提示病灶残留6例,其中CINⅠ3例,CINⅡ1例, CINⅢ2例,病灶残存率为4.3%.两者病变残存率比较差异有统计学意义(P<0.05).结论 阴道镜下宫颈活检由于取材有限,诊断存在局限性,有漏诊宫颈癌的风险,宫颈冷刀锥切术后切缘阳性者病灶残留率高,需进一步手术处理,切缘阴性者有一定比例病灶残留,如无高危因素,且有密切随访条件,可选择门诊密切随访.%Objective To analyze the pathological results of total hysterectomy after cervical cold knife conization in patients with high level cervical intraepithelial neoplasia(CIN)Ⅲ,and discuss the further treatment of CIN Ⅲ patients after cervical cold knife conization. Methods The clinical data of 140 patients with CIN Ⅲ were analyzed retrospectively,all of them who were underwent hysterectomy after cervical cold knife coning. Results Of the 140 patients,102(72.9%)patients were diagnosed with cervical biopsy under colposcopy and the pathological results were consistent with cold knife coning,18 cases(12.9%)were histopathological degraded and 20 cases(14.3%)were histopathological upgraded,of which 5 were upgraded to infiltrating cancer. After cold knife conization of the cervix,32 cases were positive and 108 cases were negative. In the margin positive patients,postoperative pathology revealed 15 residual lesions,including 5 cases of CIN Ⅰ,3 cases of CIN Ⅱ,6 cases of CIN Ⅲ,1 case of cervical cancer in IA1 stage,and the residual rate of focus was 46.9%(15/32). Among the patients with negative margin,postoperative pathology revealed 6 cases of residual lesions,including 3 cases of CIN Ⅰ,1 case of CIN Ⅱ,2 cases of CIN Ⅲ,and the residual rate of focus was 4.3%(6/140). There was statistical difference in the rate of residual lesions between 2 groups(P<0.05). Conclusions Colposcopy biopsy is limited because of limited sampling,and there is a risk of missed diagnosis of cervical cancer. The residual rate of the lesion is high in the patients with positive cervix cold knife coning,which needs further operation. There is a certain proportion of residual lesions in patients with margin negative,such as no high-risk factors and have close follow up conditions,and the close follow-up of outpatients can be selected.
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