Tasci Tolga, Turan Taner, Ureyen Isin, Karalok Alper, Kalyoncu Rukiye, Boran Nurettin, Tulunay Gokhan
Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
J Low Genit Tract Dis. 2015 Apr;19(2):115-8. doi: 10.1097/LGT.0000000000000079.
We aimed to identify if there is any predictor of residual disease at repeat operation after cervical conization with positive surgical margins for high-grade squamous intraepithelial lesion (HSIL) or microinvasive cervical cancer.
Records of patients who underwent immediate repeat conization or hysterectomy because of positive surgical margins for HSIL or microinvasive cervical cancer reported after conization were obtained. The relation between the residual disease and age, parity, menopausal status, and the factors of first conization (method, cone base area, height of cone, endocervical margin, glandular and endocervical curettage specimen involvement, and the number of quadrants with positive surgical margins) was assessed. Standard statistical tests were used.
Seventy-four patients were included. Mean time between the 2 operations was 5.1 weeks. Thirty-four patients (45.9%) had residual disease in the second-operation specimen: 4 low-grade squamous intraepithelial lesions, 24 HSILs, 5 microinvasive lesion, and 1 invasive cervical carcinoma. The number of involved quadrants was the only predictor of residual disease (41% if ≤2 and 80% if >2, p = .02).
Residual disease is found in nearly half of repeat operations after conization with positive margins for HSIL or microinvasive cervical cancer. Particularly, residual disease is present in 80% of the patients with more than 2 involved quadrants. This should be considered when making management decisions.
我们旨在确定对于高级别鳞状上皮内病变（HSIL）或微浸润性宫颈癌，宫颈锥切术后手术切缘阳性的再次手术中，是否存在残余病灶的预测因素。
获取因锥切术后HSIL或微浸润性宫颈癌手术切缘阳性而接受即刻再次锥切或子宫切除术的患者记录。评估残余病灶与年龄、产次、绝经状态以及首次锥切的因素（方法、锥底面积、锥高、宫颈管切缘、腺体及宫颈管刮除标本受累情况以及手术切缘阳性的象限数）之间的关系。使用标准统计检验。
纳入74例患者。两次手术之间的平均时间为5.1周。34例患者（45.9%）在二次手术标本中有残余病灶：4例低级别鳞状上皮内病变、24例HSIL、5例微浸润性病变和1例浸润性宫颈癌。受累象限数是残余病灶的唯一预测因素（≤2个象限时为41%，>2个象限时为80%，p = 0.02）。
对于HSIL或微浸润性宫颈癌锥切术后切缘阳性的再次手术，近半数存在残余病灶。特别是，超过2个象限受累的患者中80%存在残余病灶。在做出管理决策时应考虑这一点。
