两种子宫颈锥切术治疗子宫颈癌前病变疗效及对保留生育功能影响研究
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摘要
目的探讨冷刀-电刀-冷刀子宫颈锥切术(C-E-CKC)与冷刀锥切术(CKC)治疗子宫颈癌前病变的疗效以及对保留生育功能的影响。方法收集2013年1月至2017年1月在中国医科大学附属盛京医院因子宫颈上皮内瘤变(CIN)2、CIN3行子宫颈锥切术的患者138例作为研究对象,分为C-E-CKC组(81例)和CKC组(57例),比较两组患者的手术时间、术中出血量、切除锥体长度、手术前后病理符合率、切缘阳性率、术后病变残留和复发率、术后并发症发生率、妊娠情况及结局。结果 C-E-CKC组与CKC组的手术时间分别为(29.60±5.98)min和(33.67±5.95)min;术中出血量分别为(14.01±12.00)mL和(19.56±16.10)mL;C-E-CKC组Ⅰ、Ⅱ、Ⅲ型转化区切除锥体长度分别为(1.56±0.18)cm、(1.58±0.24)cm和(1.67±0.29)cm,CKC组分别为(1.71±0.34)cm、(1.80±0.37)cm和(2.20±0.27)cm,上述指标两组间差异均有统计学意义(均P<0.05)。两组患者手术前后病理符合率、切缘阳性率、术后病变残留及复发率、术后并发症发生率及妊娠结局等比较,差异均无统计学意义(均P>0.05)。结论两种手术方法治疗子宫颈癌前病变CIN2、CIN3均安全有效;C-E-CKC手术时间短,术中出血少,切除子宫颈组织小,对子宫颈的创伤更小,可能更适合于保留生育功能。
Objective To discuss the effects of C-E-CKC and CKC in treating precancerous lesions of the cervix(CIN2,CIN3)and its influence on fertility preservation.Methods Select 138 patients who accepted conization of cervix with CIN2,CIN3 from January 2013 to January 2017 in our hospital,the C-E-CKC group consisted of 81 cases and the CKC group 57 cases.Compare the average operation time,the average intraoperative blood loss,cone length,the preoperative and postoperative pathological coincidence rates,the positive rate of the tangent margin,the rate of the recurrence rate,postoperative complications rate,and the pregnancy situation and outcome of two groups.Results The average operation time of C-E-CKC and CKC group was(29.60±5.98)min and(33.67±5.95)min,respectively,and the average intraoperative blood loss was(14.01±12.00)mL and(19.56±16.10)mL.In C-E-CKC group,the conical excision length of type I,Ⅱ and Ⅲ transformation zone was(1.56±0.18)cm,(1.58±0.24)cm and(1.67±0.29)cm,while in CKC group,it was(1.71 ±0.34)cm,(1.80±0.37)cm and(2.20±0.27)cm,and the differences between the groups were statistically significant(P<0.05).There was no significant difference in the preoperative and postoperative pathological coincidence rates,the positive rate of the tangent margin,the recurrence rate,postoperative complications rate or the pregnancy outcome between the two groups(P>0.05).Conclusion The two methods are both safe and effective for treating precancerous lesions of the cervix(CIN2,CIN3).C-E-CKC is with shorter operation time,less intraoperative bleeding and smaller excision of cervical tissue,and the damage to cervix is smaller,which is more suitable for patients to preserve fertility.
Objective To discuss the effects of C-E-CKC and CKC in treating precancerous lesions of the cervix(CIN2,CIN3)and its influence on fertility preservation.Methods Select 138 patients who accepted conization of cervix with CIN2,CIN3 from January 2013 to January 2017 in our hospital,the C-E-CKC group consisted of 81 cases and the CKC group 57 cases.Compare the average operation time,the average intraoperative blood loss,cone length,the preoperative and postoperative pathological coincidence rates,the positive rate of the tangent margin,the rate of the recurrence rate,postoperative complications rate,and the pregnancy situation and outcome of two groups.Results The average operation time of C-E-CKC and CKC group was(29.60±5.98)min and(33.67±5.95)min,respectively,and the average intraoperative blood loss was(14.01±12.00)mL and(19.56±16.10)mL.In C-E-CKC group,the conical excision length of type I,Ⅱ and Ⅲ transformation zone was(1.56±0.18)cm,(1.58±0.24)cm and(1.67±0.29)cm,while in CKC group,it was(1.71 ±0.34)cm,(1.80±0.37)cm and(2.20±0.27)cm,and the differences between the groups were statistically significant(P<0.05).There was no significant difference in the preoperative and postoperative pathological coincidence rates,the positive rate of the tangent margin,the recurrence rate,postoperative complications rate or the pregnancy outcome between the two groups(P>0.05).Conclusion The two methods are both safe and effective for treating precancerous lesions of the cervix(CIN2,CIN3).C-E-CKC is with shorter operation time,less intraoperative bleeding and smaller excision of cervical tissue,and the damage to cervix is smaller,which is more suitable for patients to preserve fertility.
引文
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[6]Bjorge T,Skare GB,Bjorge L,et al.Adverse Pregnancy Outcomes After Treatment for Cervical Intraepithelial Neoplasia[J].Obstet Gynecol,2016,128(6):1265-1273.
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[8]Janc?ar N,Mihevc PB,Tom?ic?S.Cold-knife conisation and large loop excision of transformation zone significantly increase the risk for spontaneous preterm birth:a population-based cohort study[J].Eur J Obstet Gynecol Reprod Biol,2016,203:245-249.
[9]Jiang Y,Chen C,Li L.Comparison of Cold-Knife Conization versus Loop Electrosurgical Excision for Cervical Adenocarcinoma In Situ(ACIS):A Systematic Review and Meta-Analysis[J].PLoS One,2017,12(1):e0170587.
[10]Berretta R,Gizzo S,Dall'Asta A,et al.Risk of preterm delivery associated with prior treatment of cervical precancerous lesion according to the depth of the cone[J].Dismarkers,2013,35(6):721-726.
[11]Aleman JM,Arlien F,Tjalma WAA.The impact of conisation on pregnancy outcome[J].Eur J Gynaecol Oncol,2016,37(6):786-791.
[12]Santesso N,Mustafa RA,Wiercioch W,et al.Systematic reviews and meta-analyses of benefits and harms of cryotherapy,LEEP,and coldknife conization to treat cervical intraepithelial neoplasia[J].Int J Gynaecol Obstet,2016,132(3):266-271.
[13]黄雪芳,陈艳,庞燕,等.子宫颈环形电切术与冷刀锥切术治疗子宫颈上皮内瘤变的效果比较[J].临床医学杂志,2018,38(11):17-19.
[14]李芳梅,张颐.宫颈锥切术后切缘阳性补充手术必要性研究[J].中国实用妇科与产科杂志,2018,34(3):328-330.
[2]Nohr B,Tabor A,Frederiksen K,et al.Loop electrosurgical excision of the cervix and the subsequent risk of preterm delivery[J].Acta Obstet Gynecol Scand,2007,86(5):596-603.
[3]Santesso N,Mustafa RA,Wiercioch W,et al.Systematic reviews and meta-analyses of benefits and harms of cryotherapy,LEEP,and cold knife conization to treat cervical intraepithelial neoplasia[J].Int J Gynaecol Obstet,2016,132(3):266-271.
[4]Bj?rge T,Skare GB,Bj?rge L,et al.Adverse Pregnancy Outcomes After Treatment for Cervical Intraepithelial Neoplasia[J].Obstet Gynecol,2016,128(6):1265-1273.
[5]Ding L,Li M,Yan L,et al.Effect of cervical conization on pregnancy outcome of in-vitro fertilization/intracytoplasmic sperm injection treatment:a retrospective cohort study[J].Clin Exp Obstet Gynecol,2016,43(4):546-549.
[6]Bjorge T,Skare GB,Bjorge L,et al.Adverse Pregnancy Outcomes After Treatment for Cervical Intraepithelial Neoplasia[J].Obstet Gynecol,2016,128(6):1265-1273.
[7]Brie C,Turck M,Cheret A,et al.Case-control study of obstetrical outcomes of conisation[J].Gynecol Obstet Biol Reprod,2016,45(2):192-197.
[8]Janc?ar N,Mihevc PB,Tom?ic?S.Cold-knife conisation and large loop excision of transformation zone significantly increase the risk for spontaneous preterm birth:a population-based cohort study[J].Eur J Obstet Gynecol Reprod Biol,2016,203:245-249.
[9]Jiang Y,Chen C,Li L.Comparison of Cold-Knife Conization versus Loop Electrosurgical Excision for Cervical Adenocarcinoma In Situ(ACIS):A Systematic Review and Meta-Analysis[J].PLoS One,2017,12(1):e0170587.
[10]Berretta R,Gizzo S,Dall'Asta A,et al.Risk of preterm delivery associated with prior treatment of cervical precancerous lesion according to the depth of the cone[J].Dismarkers,2013,35(6):721-726.
[11]Aleman JM,Arlien F,Tjalma WAA.The impact of conisation on pregnancy outcome[J].Eur J Gynaecol Oncol,2016,37(6):786-791.
[12]Santesso N,Mustafa RA,Wiercioch W,et al.Systematic reviews and meta-analyses of benefits and harms of cryotherapy,LEEP,and coldknife conization to treat cervical intraepithelial neoplasia[J].Int J Gynaecol Obstet,2016,132(3):266-271.
[13]黄雪芳,陈艳,庞燕,等.子宫颈环形电切术与冷刀锥切术治疗子宫颈上皮内瘤变的效果比较[J].临床医学杂志,2018,38(11):17-19.
[14]李芳梅,张颐.宫颈锥切术后切缘阳性补充手术必要性研究[J].中国实用妇科与产科杂志,2018,34(3):328-330.