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背景与目的:宫颈鳞癌ⅠA1期术前诊断和处理仍有争议,本研究旨在探讨ⅠA1期宫颈鳞癌诊断和处理的恰当方式。方法:回顾分析我院1992～2001年收治的30例宫颈鳞癌ⅠA1期患者的临床和病理资料。结果:30例患者中7例既无症状又无明显体征(23.3%)。23例行细胞学检查,阳性率为86.9%(20/23);23例行阴道镜检查,准确率为78.2%(18/23);10例行宫颈管刮取术,4例阳性。30例患者中22例行广泛或次广泛全子宫切除术(73.3%),6例行全子宫切除术,2例行宫颈冷刀锥切术;28例子宫切除标本宫旁组织均未受侵,阴道残端均无癌残留,其中8例行盆腔淋巴结清扫术,平均切除淋巴结22枚,均为阴性,两例锥切标本切缘干净;术前诊断与最后诊断符合率为56.7%(17/30)。术后中位随访时间34个月(17～111个月),均无复发。结论:ⅠA1期宫颈鳞癌术前阴道镜检查及宫颈多点活检诊断准确率低;冷刀锥切可提高诊断准确率,同时又可作为要求保留生育功能的ⅠA1期宫颈鳞癌患者的治疗方式。
BACKGROUND & OBJECTIVE: Preoperative diagnosis and treatment of stage ⅠA1 cervical squamous cell carcinoma is still controversial. This study aimed to investigate the appropriate method for diagnosis and treatment of cervical squamous carcinoma stage ⅠA1. Methods: The clinical and pathological data of 30 patients with cervical squamous carcinoma ⅠA1 treated in our hospital from 1992 to 2001 were retrospectively analyzed. Results: Seven of the 30 patients had neither symptoms nor signs (23.3%). 23 cases of cytology, the positive rate was 86.9% (20/23); 23 cases colposcopy, the accuracy rate was 78.2% (18/23); 10 cases of cervical canal scraping surgery, 4 cases were positive. Among the 30 patients, 22 patients underwent extensive or subtotal hysterectomy (73.3%), 6 underwent hysterectomy and 2 underwent cold knife conization; 28 of 28 patients underwent hysterectomy without uterine invasion , No vaginal residual stump cancer residues, of which 8 cases of pelvic lymph node dissection, the average removal of lymph nodes 22, were negative, two cases of conical specimens margin margin clean; preoperative diagnosis and final diagnosis of 56.7% (17 / 30). After the median follow-up time of 34 months (17 ~ 111 months), no recurrence. Conclusion: ⅠA1 stage cervical squamous cell carcinoma before colposcopy and cervical multi-point biopsy diagnostic accuracy is low; cold knife conization can improve the diagnostic accuracy, but also can be used as a reproductive function require retention of ⅠA1 cervical squamous cell carcinoma of the treatment .