[1]效小莉 付凤仙*.宫腔镜下宫颈锥切术在宫颈锥切术后宫颈上皮内瘤变中的应用价值[J].中国微创外科杂志,2021,01(7):619-623.
　Xiao Xiaoli,Fu Fengxian..Value of Transcervical Resection of Cervical Lesion in the Treatment of Cervical Intraepithelial Neoplasia After Conization[J].Chinese Journal of Minimally Invasive Surgery,2021,01(7):619-623.
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宫腔镜下宫颈锥切术在宫颈锥切术后宫颈上皮内瘤变中的应用价值()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年7期
页码:
619-623
栏目:
临床研究
出版日期:
2021-07-25

文章信息/Info

Title:
Value of Transcervical Resection of Cervical Lesion in the Treatment of Cervical Intraepithelial Neoplasia After Conization
作者:
效小莉 付凤仙*
（航天中心医院妇产科，北京100049）
Author(s):
Xiao Xiaoli;  Fu Fengxian.
Department of Obstetrics & Gynaecology, Aerospace Center Hospital, Beijing 100049, China
关键词:
宫腔镜下宫颈锥切术; 宫颈锥切术; 宫颈上皮内瘤变
Keywords:
Transcervical resection of cervical lesion; Conization; Cervical intraepithelial neoplasia
文献标志码:
A
摘要:
目的探讨宫腔镜下宫颈锥切术（transcervical resection of cervical lesion，TCRC）在宫颈锥切术后宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）二次手术中的安全性及有效性。方法2017年1月~2019年12月对54例有宫颈锥切手术史CIN，在宫腔镜下自宫颈６点位开始，顺时针方向用环状电极自组织学内口向外，环形切除包括鳞柱交接区的宫颈组织，终止于病变外缘3~5 mm处，直至完成锥高20~30 mm的多条状宫颈锥形切除。结果手术过程均顺利，手术时间（14.3±2.2）min，术中出血量（4.8±1.4）ml。术中无子宫穿孔、宫腔假道形成、前列腺电切综合征、膀胱直肠损伤等并发症，术后无感染及宫颈出血。术后病理未升级94.4%（51/54），升级率5.6%（3/54）。47例术后12个月HPV分型：16例术前HPV16型和18型感染，术后持续HPV16型感染1例，3例转为其他12种高危HPV感染，12例转阴；术前高危型HPV感染44例，术后12个月持续感染9例，总HPV转阴率79.5%（35/44）。TCRC后子宫切除9例，2例子宫切除术后宫颈残端阳性（CIN1和CIN2各1例），其中8例术后随访3~27个月，中位随访时间6个月，术后均恢复良好。结论TCRC治疗宫颈锥切术后CIN安全、有效、微创。
Abstract:
ObjectiveTo investigate the clinical efficacy and safety of transcervical resection of cervical lesion（TCRC） as the second operation mode for cervical intraepithelial neoplasia (CIN) in patients after conization.MethodsA retrospective analysis was made on clinical data of 54 cases of CIN treated in our hospital from January 2017 to December 2019. Starting from 6 o’clock of the cervix, the cervical tissue including the squamous column junction area was excised with a hysteroscopy circular electrode from the inner opening of the histology to the outside in a clockwise direction, and the cervical tissue was terminated at the outer edge of the lesion at 3-5 mm, until the multiple strip cervical conization with a cone height of 20-30 mm was completed. The clinical treatment efficacy and prognosis of the patients were reviewed.ResultsThe operation time was (14.3±2.2) min, and the blood loss was (4.8±1.4) ml. No secondary injury such as uterine perforation, false passage, transurethral resection syndrome, bladder and rectal injury happened. No bleeding or infection occurred during perioperative period. The postoperative histologic diagnosis were compared with the preoperation histologic diagnosis, in which 51 not upgraded (94.4%) and 3 upgraded (5.6%). There were 16 cases of HPV16 and HPV18 infection before operation and 1 case of persistent HPV16 infection after operation. In addition, there were 44 cases of highrisk HPV infection before operation while 9 cases of persistent infection after operation. The total HPV conversion rate was 79.5% (35/44). A total of 9 patients underwent hysterectomy, and 2 patients had residual disease (1 case of CIN1 and 1 case of CIN2) after hysterectomy. Among them, 8 patients were followed up for 3-27 months (median, 6 months). All the patients recovered well after operation.ConclusionFor patients with CIN after conization, TCRC is a safe, effective and relatively microinvasive treatment.

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备注/Memo

备注/Memo:
*通讯作者，Email:fufx1@126.com
更新日期/Last Update: 2021-10-11