Ostör A G, Duncan A, Quinn M, Rome R
Department of Pathology, University of Melbourne, Melbourne, Victoria, 3053, Australia.
Gynecol Oncol. 2000 Nov;79(2):207-10. doi: 10.1006/gyno.2000.5957.
The aim of this study was to ascertain whether cold knife conization alone for cervical adenocarcinoma in situ is safe.
One hundred consecutive patients with a histologically proven adenocarcinoma in situ (AIS) of the cervix were studied from 1970 to 1992.
Ninety-two women presented with abnormal smears, and of these 56% contained abnormal glandular cells. Sixty-seven (74%) of 90 women who underwent colposcopy had an abnormal examination, but a glandular abnormality was suspected in only 19 (28%). In all, 80 cold knife conizations were performed. In 7, no abnormality was found following punch biopsy. The margins were free of disease in 55 (75%). The most commonly involved margin in the remainder was the apical. Conization was followed by hysterectomy in 20 women: in 8 of these the cone margins were free and residual disease was found in 2 of the extirpated uteri: as these were extramural cases, inadequate sampling could not be excluded. Of the 12 women where hysterectomy followed conization with diseased margins, 9 had residual disease in the hysterectomy specimen. The definitive therapy was cold knife conization in 56 patients, hysterectomy in 38, and electrocoagulation diathermy in 6. Follow-up of the 53 patients treated by conization alone ranging from 1 to 16 years, with a mean of 8 years (3 have been lost to follow-up) revealed no recurrence of AIS or adenocarcinoma to date.
It is concluded that cold knife conization is a safe therapeutic modality, provided that the cone biopsy has been adequately sampled and the margins are free.
本研究旨在确定单纯冷刀锥切术治疗宫颈原位腺癌是否安全。
对1970年至1992年间连续100例经组织学证实为宫颈原位腺癌（AIS）的患者进行研究。
92例女性出现异常涂片，其中56%含有异常腺细胞。90例接受阴道镜检查的女性中，67例（74%）检查结果异常，但仅19例（28%）怀疑有腺性异常。总共进行了80例冷刀锥切术。7例在穿刺活检后未发现异常。55例（75%）切缘无病变。其余病例中最常受累的切缘是顶端切缘。20例女性在锥切术后接受了子宫切除术：其中8例锥切缘无病变，2例切除的子宫中发现残留病变：由于这些是子宫外病变，不能排除取样不足的情况。在12例切缘有病变的锥切术后接受子宫切除术的女性中，9例子宫切除标本中有残留病变。56例患者的最终治疗方法是冷刀锥切术，38例是子宫切除术，6例是电凝透热疗法。对53例仅接受锥切术治疗的患者进行了1至16年的随访，平均随访8年（3例失访），迄今为止未发现AIS或腺癌复发。
得出的结论是，只要锥切活检取样充分且切缘无病变，冷刀锥切术是一种安全的治疗方式。
