Mazouni Chafika, Porcu Geraldine, Haddad Olivier, Dalès Jean-Philippe, Taranger-Charpin Colette, Piana Lucien, Bonnier Pascal
Department of Oncologic Gynecology, Marseille Public Hospital System (APHM), Hôpital de la Conception, Service de Gynécologie A, Marseille, France.
Eur J Obstet Gynecol Reprod Biol. 2005 Jul 1;121(1):86-93. doi: 10.1016/j.ejogrb.2004.11.018.
The purpose of this study was to evaluate a conservative cold-knife section technique for treatment of cervical intraepithelial neoplasia (CIN). This procedure can be adapted to patient age, preservation of childbearing potential and extent of dysplasia.
Prospective study.
Gynecological Oncology Department in French Public Hospital.
A total of 460 women treated for CIN between 1985 and 1999 were included.
A conservative cold-knife cervical section followed by blanket suture reconstruction was used in all cases.
Immediate operative results, recurrence and reproductive function were assessed.
The mean length of the cervical specimen was 11.4 mm (range, 4-22 mm). Mean specimen thickness was strongly correlated with age: 10.6 +/- 4.1 mm in women <40 years versus 12.1 in women >40 years; p < 0.001. Complete excision was achieved in 395 cases (85.8%). Post-operative bleeding was observed in 5 cases (1.1%). The mean duration of follow-up was 62 months (range, 12.3-156.5 months). Recurrences developed in 26 patients (6.6%) including CIN 1 in 9 cases, CIN 2 in 9 and CIN 3 in 8. No patient developed carcinoma. The actuarial risk of recurrence was 2.4% (+/- S.D., 0.9) at 24 months and 7.8% (+/-S.D., 1.9) at 60 months. A total of 52 pregnancies were observed in 39 patients. No case of de novo infertility was reported post-operatively. Amenorrhea was noted in 1 patient (0.1%) and dysmenorrhea in 1 patient (0.1%).
This conservative cold-knife section technique is effective for treatment of CIN with low morbidity and little adverse effect on childbearing potential. Exposure of the squamocolumnar junction (SCJ) greatly facilitates follow-up.
本研究旨在评估一种用于治疗宫颈上皮内瘤变（CIN）的保守性冷刀切除术技术。该手术可根据患者年龄、生育潜能的保留情况以及发育异常的程度进行调整。
前瞻性研究。
法国公立医院妇科肿瘤科。
纳入了1985年至1999年间接受CIN治疗的460名女性。
所有病例均采用保守性冷刀宫颈切除术，随后进行毯式缝合重建。
评估即时手术结果、复发情况和生殖功能。
宫颈标本的平均长度为11.4毫米（范围为4 - 22毫米）。标本平均厚度与年龄密切相关：40岁以下女性为10.6±4.1毫米，40岁以上女性为12.1毫米；p < 0.001。395例（85.8%）实现了完全切除。5例（1.1%）出现术后出血。平均随访时间为62个月（范围为12.3 - 156.5个月）。26例患者（6.6%）复发，其中9例为CIN 1，9例为CIN 2，8例为CIN 3。无患者发展为癌。24个月时复发的精算风险为2.4%（±标准差，0.9），60个月时为7.8%（±标准差，1.9）。共观察到39例患者有52次妊娠。术后未报告新发不孕病例。1例患者（0.1%）出现闭经，1例患者（0.1%）出现痛经。
这种保守性冷刀切除术技术治疗CIN有效，发病率低，对生育潜能几乎无不良影响。鳞柱交界（SCJ）的暴露极大地便于随访。
