Yamamoto Rumiko, Sekiyama Kentaro, Higuchi Toshihiro, Ikeda Masae, Mikami Mikio, Kobayashi Yoichi, Nagase Satoru, Yokoyama Masatoshi, Enomoto Takayuki, Katabuchi Hidetaka
Department of Obstetrics and Gynecology, Kitano Hospital, The Tazuke Kohukai Medical Research Institute, Osaka, Japan.
Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan.
J Obstet Gynaecol Res. 2019 Dec;45(12):2419-2424. doi: 10.1111/jog.14118. Epub 2019 Oct 1.
In the recent years, the number of cervical conization procedures performed for diagnostic or therapeutic purposes is increasing, accompanied by increased cervical neoplasia among young women. This study aimed to analyze the clinical data of patients who underwent conization in Japan.
Among the 14 832 cases of conization registered in 205 facilities over 2 years (2009-2011), the data of 2409 and 12 417 patients who underwent conization for diagnostic and therapeutic purposes, respectively, were retrospectively analyzed.
The median age of the patients in diagnostic and therapeutic conization groups was 44 and 37 years, respectively. When comparing the diagnostic and therapeutic groups, 25.5% of the patients in the former were suspected with invasive cancer preoperatively, which is higher than that in the latter (2.7%). About 25.7% in the diagnostic and 14.1% in the therapeutic group had positive margin in the conization specimens. Additional treatment was required for 36.0% and 5.5% of the patients in the diagnostic and therapeutic groups, respectively, which are high figures for both. The risk factors of pathological upgrade in the conization specimens were diagnostic purpose, postmenopausal status and glandular lesion. Additional hysterectomy was performed in 1304 patients after conization, and pathological diagnosis was upgraded in 550 cases. Multivariate analysis revealed that postmenstrual status was an independent risk factor.
This study revealed that cervical lesions of glandular lineage and patients with postmenopausal status benefit from diagnostic conization. However, in postmenopausal patients, the underlying disease cannot be excluded in the preserved uterus even by diagnostic conization.
近年来，出于诊断或治疗目的而进行的宫颈锥切术数量不断增加，与此同时年轻女性宫颈肿瘤的发病率也在上升。本研究旨在分析在日本接受锥切术患者的临床资料。
在205家医疗机构登记的2年（2009 - 2011年）内的14832例锥切术病例中，分别对2409例因诊断目的和12417例因治疗目的接受锥切术的患者数据进行回顾性分析。
诊断性锥切组和治疗性锥切组患者的中位年龄分别为44岁和37岁。比较诊断组和治疗组时，前者术前怀疑有浸润癌的患者占25.5%，高于后者（2.7%）。诊断组约25.7%的患者和治疗组14.1%的患者锥切标本切缘阳性。诊断组和治疗组分别有36.0%和5.5%的患者需要进一步治疗，两者比例都较高。锥切标本病理升级的危险因素为诊断目的、绝经状态和腺性病变。1304例患者在锥切术后进行了子宫切除术，其中550例病理诊断升级。多因素分析显示绝经状态是独立危险因素。
本研究表明，腺性谱系宫颈病变患者和绝经状态患者从诊断性锥切术中获益。然而，对于绝经后患者，即使进行诊断性锥切，保留子宫内的潜在疾病也不能排除。
