%0 Journal Article %T 宫颈锥切范围的临床研究 %A 何拉曼 %A 郭晓青 %A 俞尔慨 %J 同济大学学报(医学版) %D 2016 %R 10.16118/j.1008-0392.2016.05.020 %X 目的 探讨生育年龄女性因宫颈高级别鳞状上皮内病变行宫颈锥形切除术的适宜范围。方法 将98例因宫颈高级别鳞状上皮内病变行宫颈锥切术的有生育要求的生育年龄女性患者分成A、B组,A组51例,B组47例,两组各有2例阴道镜示不满意,转化区为3型。两组锥底宽度为碘不着色区外3～5mm；A、B组锥切高度为10～15、16～25mm。对两组手术时间、术中出血量、住院时间、切缘阳性率、术后晚期出血及宫颈粘连、治愈时间及术后3、6个月随访结果统计分析。结果 A、B组手术时间分别为(15±5.5)、(18±5.2)min,术中出血量分别为(20±9.5)、(28±10.5)ml(P<0.001),差异有统计学意义(P＜0.05)。A、B组住院时间分别为(2.0±0.64)、(2.0±0.73)d,差异无统计学意义(P>0.05)。A组切缘阳性率3.9%(2例),B组切缘阳性率2.1%(1例),均为3型转化区患者,1个月后此3例再次宫颈补切后切缘转为阴性。术后2周左右,B组发生宫颈创面大出血1例,行缝扎止血；A组无大出血病例。两组无1例宫颈粘连或狭窄发生。术后4～5周随访结果显示: 两组宫颈伤口均已痊愈,宫颈形状均恢复良好。术后3、6个月复诊,两组TCT均阴性,A组有2例(3.9%)HPV-DNA阳性,B组1例(2.1%)HPV-DNA阳性,差异均无统计学意义(P>0.05) 结论 患宫颈高级别鳞状上皮内病变的生育年龄女性,如宫颈转化区为1和2型,高度仅需10～15mm的宫颈锥切术将有利于今后的妊娠结局,而3型转化区患者则需切除更深更多的组织方能保证切净病变组织。</br>Objective To explore the appropriate range of resection in cervical conization for reproductive-age women with cervical high-grade squamous intraepithelial lesions(HSIL). Methods Ninety eight reproductive-age patients with HSIL were divided into group A (n=51) and group B (n=47) ; there were 2 patients with unsatisfied colposcopic results and cervical transformation zone (CTZ) type 3 in each group. The width at the bottom of conization was 3-5 mm beyond the iodine-unstained zone in both groups, but the depth was different. The heights of conization in group A and group B were 10-15mm and 16-25mm, respectively. The operation time, intraoperative blood loss, length of hospital stay, rate of positive margin of conization, post-operative bleeding volume and occurrence rate of cervical adhesion,healing time,results of post-operation follow-up were analyzed in two groups. Results The operation time of groups A and B was 15±5.5 and 18±5.2min (P<0.01). Intraoperative blood loss of groups A and B was 20±9.5 and 28±10.5ml (P<0.001). Length of hospital stay in groups A and B was 2.0±0.64,2.0±0.73d (P>0.05). The rate of positive margin of conization was 3.9% (2/51) in group A and 2.1% (1/47) in group B. The positive margin was all from patients with CTZ3, who underwent another conization 1 month later and got negative margin. None in group A had post-operative bleeding in two weeks, but one case (2.1%) in group B had postoperative bleeding.There was no cervical adhesion or narrow in both groups. The follow-up at 3,6 month after operation showed that wounds were healed well and the cervix had good shape in both groups. The follow-up showed that the TCT was negative in both groups and 2 cases (3.9%) in group A and 1 case in group B (2.1%) presented positive HPV-DNA. Conclusion Reproductive-age women with CTZ 1 and 2 cervical HSIL can undergo conizations with depth %K 高级别鳞状上皮内病变 宫颈锥切术 宫颈转化区< %K /br> %K cervical high-grade squamous intraepithelial lessions conization cervical transformation zone %U http://tjyxxb.cnjournals.cn/ch/reader/view_abstract.aspx?file_no=20160520&flag=1