Gilbert L, Saunders N, Sharp F
University Department of Obstetrics and Gynecology, Northern General Hospital, Sheffield, United Kingdom.
Obstet Gynecol. 1990 Jul;76(1):101-5.
The ideal cone biopsy should have its apex just above the transformation zone to ensure removal of all abnormal squamous and metaplastic epithelium in the endocervix, with only minimal normal glandular tissue included. The microhysteroscope has been shown to be useful in identifying the upper limit of the transformation zone within the canal, and this distance from the external os can be measured. However, this technique has not been evaluated to determine whether it can tailor cone length to this predetermined measurement. We report an observational analysis of 176 consecutive conizations in patients with colposcopically proved extension of abnormal epithelium high into the cervical canal. In 162 cases, the distance of the transformation zone from the external os could be measured with the microhysteroscope and its endocervicometer, permitting an attempt to tailor the cone length to this measurement plus a safety margin of 5 mm. There was good correlation between the intended cone length and the excised cone length, with 85% of the excised cones falling within 5 mm above or below the intended measurement. In 153 instances (94.4%), the excised cones had clear endocervical margins. Thus, tailoring of the cone length to the hysteroscopically determined measurement is feasible, thereby increasing the chances of complete excision while limiting cone size to the required minimum.
理想的锥形活检其顶点应恰好在转化区上方，以确保切除宫颈管内所有异常的鳞状和化生上皮，仅包含极少的正常腺组织。微型宫腔镜已被证明有助于确定宫颈管内转化区的上限，并且可以测量该距离外口的长度。然而，尚未对该技术进行评估以确定其是否能根据这一预定测量值来调整锥形长度。我们报告了对176例经阴道镜证实异常上皮向宫颈管高位延伸患者连续进行锥形切除的观察性分析。在162例病例中，可使用微型宫腔镜及其宫颈管测量仪测量转化区距外口的距离，从而尝试根据该测量值加上5mm的安全边缘来调整锥形长度。预期锥形长度与切除的锥形长度之间具有良好的相关性，85%的切除锥形长度在预期测量值上下5mm范围内。在153例（94.4%）病例中，切除的锥形具有清晰的宫颈管边缘。因此，根据宫腔镜测定的测量值调整锥形长度是可行的，从而增加了完全切除的机会，同时将锥形大小限制在所需的最小值。
