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目的分析子宫颈微小浸润癌(MIC)的临床特点,探讨采用子宫颈锥形切除术(宫颈锥切)治疗的可行性。方法分析2005年11月至2007年10月在北京协和医院经宫颈锥切确诊为MIC31例患者的临床表现、锥切病理、后续处理及预后。结果31例MIC患者中,24例有宫颈细胞学结果。所有患者均有阴道镜活检结果,其中1例(3.2%)子宫颈上皮内瘤变2级(CINⅡ),17例(54.8%)为宫颈上皮内瘤变3级(CINⅢ),13例(41.9%)怀疑早期浸润癌。根据锥切病理,23例被确诊为Ⅰa1期宫颈浸润癌(Ⅰa1期宫颈癌组),8例为Ⅰa2期宫颈浸润癌(Ⅰa2期宫颈癌组)。Ⅰa1期宫颈癌组中,3例(13.0%)有生育要求且切缘阴性的患者宫颈锥切术后接受严密随诊,1例(4.3%)切缘阳性但有生育要求的患者进行了再次锥切,其余19例(82.6%)无生育要求的妇女接受了全子宫(或加双附件)切除。Ⅰa2期宫颈癌组的8例患者全部进行了根治性子宫切除。随诊中除1例保留子宫的患者细胞学提示异常、经阴道镜宫颈活检诊断为CINⅢ外,其余患者未见病变复发。保留子宫的4例随诊期间共发生3例次妊娠。结论阴道镜活检对于MIC的诊断有重要提示价值,但MIC的确诊必须通过宫颈锥切病理。MIC的锥切后处理主要基于锥切病理,同时需要考虑患者的生育要求和切缘状况。
Objective To analyze the clinical features of micro-invasive cervical cancer (MIC) and to explore the feasibility of using cervical conization (cervical conization). Methods The clinical manifestations, conization, follow-up and prognosis of patients with MIC31 diagnosed by cervix conization at Peking Union Medical College Hospital from November 2005 to October 2007 were analyzed. Results Of 31 patients with MIC, 24 had cervical cytology results. All patients had colposcopy biopsy results, including 1 case (3.2%) of cervical intraepithelial neoplasia grade 2 (CINⅡ), 17 cases (54.8%) of cervical intraepithelial neoplasia grade 3 (CIN Ⅲ), 13 cases (41.9 %) Suspected early invasive cancer. According to conization pathology, 23 cases were diagnosed as stage Ⅰa1 cervical cancer (stage Ⅰa1 cervical cancer), and 8 cases were stage Ⅰa2 cervical invasive carcinoma (stage Ⅰa2 cervical cancer). Among the patients with stage 1aa cervical cancer, 3 patients (13.0%) with reproductive requirements and negative margins were closely followed by cervical conization and 1 (4.3%) patients with positive margins but fertility required Conical cut, and the remaining 19 cases (82.6%) women without fertility requirements received a total uterus (or double attachment) resection. All 8 patients with stage Ⅰa2 cervical cancer underwent radical hysterectomy. Follow-up in addition to a case of retained uterine cytology tips abnormalities, colposcopic cervical biopsy diagnosis of CIN Ⅲ, the rest of the patients no recurrence of lesions. During the follow-up period, 3 cases of secondary pregnancy occurred in 4 cases who retained the uterus. Conclusion colposcopy biopsy for the diagnosis of MIC has important value, but the diagnosis of MIC must go through the cervical conization pathology. Cone after MIC treatment is mainly based on cone pathology, and need to consider the patient’s fertility requirements and the status of the margin.