宫颈上皮内瘤变III级：切缘阴性冷刀锥切术后的长期结局

Cervical intraepithelial neoplasia III: long-term outcome after cold-knife conization with clear margins.

作者信息

Reich O, Pickel H, Lahousen M, Tamussino K, Winter R

机构信息

Department of Obstetrics and Gynecology, University of Graz, Graz, Austria.

出版信息

Obstet Gynecol. 2001 Mar;97(3):428-30. doi: 10.1016/s0029-7844(00)01174-1.

DOI:10.1016/s0029-7844(00)01174-1

PMID:11239650

Abstract

OBJECTIVE

To evaluate the long-term outcome of patients with severe cervical intraepithelial neoplasia or squamous cell carcinoma in situ (CIN III) after cold-knife conization with clear margins.

METHODS

A total of 4417 women (mean age 36, range 18-72 years) with histologically confirmed CIN III had cold-knife conization with clear margins at our institution between 1970 and 1994. All patients were followed up with colposcopy, cytology, and pelvic examination for a mean of 18 years (range 5-30years).

RESULTS

New high-grade squamous intraepithelial lesions (SILs) (CIN II and III) developed in 15 (0.35%) patients (mean age 35, range 25-65 years) after a median of 107 (range 40-201) months. A total of 4402 (99.65%) patients (mean age 36, range 18-72 years) were free of high-grade SILs after a mean follow-up of 18 (range 5-30) years. High-grade glandular intraepithelial lesions developed in two (0.05%) patients 14 and 17 years after conization. Twelve (0.3%) patients had metachronous vulvar intraepithelial neoplasia (VIN) grade III or vaginal intraepithelial neoplasia (VAIN) grade III, and one (0.02%) patient had invasive vaginal carcinoma 10 years after conization.

CONCLUSION

Cold-knife conization with clear margins was an adequate method to definitively treat CIN III.

摘要

目的

评估切缘阴性的冷刀锥切术治疗重度宫颈上皮内瘤变或原位鳞状细胞癌（CIN III）患者的长期预后。

方法

1970年至1994年间，共有4417例经组织学确诊为CIN III的女性（平均年龄36岁，范围18 - 72岁）在本机构接受了切缘阴性的冷刀锥切术。所有患者均接受阴道镜检查、细胞学检查和盆腔检查随访，平均随访18年（范围5 - 30年）。

结果

15例（0.35%）患者（平均年龄35岁，范围25 - 65岁）在中位时间107个月（范围40 - 201个月）后出现新的高级别鳞状上皮内病变（SILs）（CIN II和III）。在平均随访18年（范围5 - 30年）后，共有4402例（99.65%）患者（平均年龄36岁，范围18 - 72岁）无高级别SILs。2例（0.05%）患者在锥切术后14年和17年出现高级别腺上皮内病变。12例（0.3%）患者出现异时性外阴上皮内瘤变（VIN）III级或阴道上皮内瘤变（VAIN）III级，1例（0.02%）患者在锥切术后10年出现浸润性阴道癌。