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目的分析宫颈上皮内瘤变(CIN)Ⅲ级患者,全宫切除术标本中病理学诊断为浸润癌的发生率,探讨需要全宫切除者术前锥切的必要性。方法回顾性分析2001年1月至2010年12月广东省人民医院妇科197例宫颈上皮内瘤变Ⅲ级锥切后,行全宫切除术患者的临床病理资料。结果全部宫颈活检诊断为CINⅢ的病例,均先行宫颈电环切除术(LEEP)或冷刀锥切术(CKC),术后3个月内,因为子宫肌瘤、子宫腺肌症或随访困难等,再接受全宫切除。197例患者中,122例在全宫切除之前行LEEP,75例行CKC。子宫标本病理提示,49例患者宫颈有病灶残留,其中36例为LEEP术后,13例为CKC术后,两种锥切手术方式病灶残留率差异有统计学意义(P<0.001),但均未发现有宫颈浸润癌。结论对需要全子宫切除的CINⅢ患者,术前不一定要先行诊断性锥切,直接切除子宫是安全的。
Objective To analyze the pathological diagnosis of invasive carcinoma in patients with grade Ⅲ cervical intraepithelial neoplasia (CIN), and to explore the necessity of preoperative conization for hysterectomy. Methods The clinical and pathological data of 197 cases of cervical intraepithelial neoplasia who underwent total hysterectomy were retrospectively analyzed from January 2001 to December 2010 in Guangdong Provincial People’s Hospital. Results All cases of cervical biopsy diagnosed as CIN Ⅲ were treated with LEEP or CKC, and within 3 months after operation, because of the difficulty of uterine fibroids, adenomyosis or follow-up , Then accept the whole house resection. Among the 197 patients, 122 had LEEP before total hysterectomy and 75 had CKC. Histological examination of the uterus revealed that there were residual lesions in 49 cases of cervical lesions, of which 36 cases were LEEP and 13 cases were CKC. There was significant difference (P <0.001) No cervical cancer was found. Conclusions For patients with CIN Ⅲ requiring total hysterectomy, it is not necessary to perform diagnostic conization before surgery. It is safe to directly remove the uterus.