Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea.
J Gynecol Oncol. 2011 Mar 31;22(1):25-31. doi: 10.3802/jgo.2011.22.1.25.
To evaluate the occurrence of residual or recurrent disease after conization for adenocarcinoma in situ (AIS) of the uterine cervix.
Medical records of 99 patients with a histologically diagnosis of AIS of the uterine cervix by conization between 1991 and 2008 were reviewed retrospectively.
Seventy eight of 99 patients (78.8%) had negative and 18 (18.2%) had positive resection margins of the conization specimen, and 3 (3.0%) had unknown margin status. Of the 78 patients with negative margins, 45 underwent subsequent hysterectomy and residual AIS were present in 4.4% (2/45) of patients. Ten of the 18 patients with positive margins received subsequent hysterectomy and 3 patients (30%) had residual AIS. Twenty-eight patients had conservative treatment and during the median follow-up time of 23.5 months (range, 7 to 124 months), only one patient (3.6%) had recurrent AIS and was treated with a simple hysterectomy. Eight patients became pregnant after conization, 4 of them delivered healthy babies, one had a spontaneous abortion and 3 were ongoing pregnancies.
Patients with positive resection margins after conization for AIS of the uterine cervix are significantly more likely to have residual disease. However, negative resection margin carries a lower risk for residual AIS, therefore conservative management with careful surveillance seems to be feasible in women who wish to preserve their fertility.
评估子宫颈原位腺癌（AIS）锥切术后残留或复发疾病的发生情况。
回顾性分析了 1991 年至 2008 年间 99 例经组织学诊断为子宫颈 AIS 行锥切术患者的病历。
99 例患者中，78 例（78.8%）锥切标本切缘阴性，18 例（18.2%）切缘阳性，3 例（3.0%）切缘状态不详。78 例切缘阴性患者中，45 例行后续子宫切除术，其中 4.4%（2/45）患者存在残留 AIS。18 例切缘阳性患者中，10 例接受了后续子宫切除术，其中 3 例（30%）存在残留 AIS。28 例患者行保守治疗，中位随访时间为 23.5 个月（范围为 7 至 124 个月），仅 1 例（3.6%）患者复发 AIS，行单纯子宫切除术治疗。8 例患者锥切术后怀孕，其中 4 例分娩健康婴儿，1 例自然流产，3 例仍在妊娠中。
子宫颈 AIS 锥切术后切缘阳性的患者更有可能存在残留疾病。然而，切缘阴性提示残留 AIS 的风险较低，因此对于希望保留生育能力的患者，行保守治疗并密切监测似乎是可行的。
