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目的探讨宫腔镜电凝辅助宫颈冷刀锥切术(cold knife conization,CKC)在重度宫颈上皮内瘤变(cer-vical intraepithelial neoplasiaⅢ)诊断治疗中的临床意义。方法回顾性分析134例CINⅢ患者,通过宫腔镜电凝辅助CKC和传统CKC的方法,了解患者术前组织活检与术后病理情况,术中术后临床观察及术前术后HPV表达变化情况。结果 134例患者中,78例行宫腔镜电凝辅助CKC,56例行传统CKC。宫腔镜电凝辅助CKC和传统CKC术后组织病理结果与术前多点活检完全符合率分别为78.21%(61/78)和75%(42/56);两组切缘病变残留率分别为6.41%(5/78)和7.14%(4/56)。术中出血分别为:19.25±10.59ml和33.63±14.56ml;手术时间分别为:14.02±4.079分钟和25.09±7.034分钟;术后并发症:出血分别为2例(均为术后2周左右)和3例(2例术后当日,1例术后2周);两组均无感染。随访6个月至4年,HPV在宫腔镜电凝辅助CKC术后3个月64例(术前72例阳性)转为阴性,转阴率为89%(64/72),传统CKC术后3个月43例(术前50例阳性)转为阴性,转阴率为86%(43/56)。两组随访至今HPV均为阴性。结论与传统的CKC相比,宫腔镜电凝辅助CKC术中出血少,手术时间短的优点,是目前治疗重度宫颈上皮内瘤变的一种较好的方法,值得推广。
Objective To investigate the clinical significance of hysteroscopic electrocoagulation in the diagnosis and treatment of severe cervical intraepithelial neoplasia (Ⅲ) with cold knife conization (CKC). Methods A retrospective analysis of 134 cases of CIN Ⅲ patients, hysteroscopic electrocoagulation assisted by CKC and traditional CKC method to understand the patient’s biopsy and postoperative pathology, intraoperative and postoperative clinical observation and preoperative and postoperative changes in HPV expression . Results Among the 134 patients, 78 patients underwent hysteroscopic electrocoagulation assisted by CKC and 56 underwent conventional CKC. Hysteroscopic electrocoagulation assisted CKC and conventional CKC postoperative histopathological findings and preoperative multi-point biopsy were fully consistent rates were 78.21% (61/78) and 75% (42/56); the residual rate of the two groups of marginal lesions were 6.41% (5/78) and 7.14% (4/56) respectively. The intraoperative bleeding were 19.25 ± 10.59ml and 33.63 ± 14.56ml respectively. The operative time was 14.02 ± 4.079 minutes and 25.09 ± 7.034 minutes respectively. The postoperative complications were bleeding in 2 cases (all about 2 weeks after operation) And 3 cases (2 cases on the day after surgery, 1 case after 2 weeks); no infection in both groups. After 6 months to 4 years of follow-up, 64 cases of HPV (positive 72 cases before surgery) turned to be negative 3 months after hysteroscopic electrocoagulation-assisted CKC, the negative conversion rate was 89% (64/72). Traditional CKC After 3 months, 43 cases (50 cases before surgery positive) turned negative, the negative conversion rate was 86% (43/56). HPV was negative in both groups till now. Conclusion Compared with the traditional CKC, hysteroscopic electrocoagulation assisted the advantages of CKC less bleeding, shorter operative time is a better method for the treatment of severe cervical intraepithelial neoplasia, which is worth promoting.