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目的了解宫颈原位癌的临床特点及治疗方法,总结不同治疗方法对宫颈癌患者生存、复发、及妊娠的影响。方法回顾性分析1987年1月至2002年10月行手术治疗的118例宫颈原位癌患者的临床表现、诊断方法、手术方式、病理结果及预后情况。患者的年龄24~77岁,平均38·8岁,宫颈细胞学检查以宫颈上皮内瘤变Ⅲ及宫颈高度鳞状上皮内瘤变为主。118患者接受了阴道镜检查,以多象限的病变为主。全部的患者接受了宫颈锥切手术,手术方式有冷刀锥切和电刀锥切两种。结果冷刀锥切64例,占54%;电刀锥切54例,占46%。两种方式在病理切净程度、手术并发症等方面差异均无统计学意义。71例(60%)患者接受锥切手术后随诊,47例(40%)患者接受全子宫(或加双附件)切除手术。17例患者宫颈锥切手术后妊娠。随诊118例患者未见有肿瘤的复发。结论宫颈原位癌的确诊应通过宫颈锥切手术,其中宫颈细胞学检查、阴道镜检查均起着重要作用。对于年轻的宫颈原位癌可以行单纯的宫颈锥切手术治疗,以保留生育功能。对于随诊困难并已经绝经的妇女可以行全子宫双附件切除手术。
Objective To understand the clinical features and treatment of cervical carcinoma in situ and summarize the effects of different treatment methods on the survival, recurrence and pregnancy of patients with cervical cancer. Methods The clinical manifestations, diagnosis methods, surgical methods, pathological findings and prognosis of 118 cases of cervical carcinoma in situ were retrospectively analyzed from January 1987 to October 2002. Patients aged 24 to 77 years, mean 38.8 years old, cervical cytology cervical intraepithelial neoplasia Ⅲ and cervical squamous intraepithelial neoplasia based. 118 patients underwent colposcopy to multi-quadrant lesions. All patients underwent cervical cone incision surgery, cold knife taper surgery and electric knife taper cut two. Results 64 cases of cold knife conization, accounting for 54%; electric knife conization in 54 cases, accounting for 46%. There was no significant difference between the two methods in the degree of pathological resection and surgical complications. Seventy-one (60%) patients were followed up after conization, and 47 (40%) patients underwent total hysterectomy (or double attachment) resection. 17 cases of cervical conization surgery after pregnancy. Follow-up of 118 patients with no tumor recurrence. Conclusions The diagnosis of cervical carcinoma in situ should be performed by cervical conization, of which cervical cytology and colposcopy play an important role. For young cervical carcinoma in situ can be simple cervical conization surgery to preserve reproductive function. For those women who have difficulty in follow-up and have already had menopause, they can undergo total hysterectomy with double attachments.