宫腔镜下宫颈“图钉形”切除术治疗有生育要求的子宫颈高级别鳞状上皮内病变的临床探讨

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摘要目的探讨宫腔镜下宫颈“图钉形”切除术在治疗有生育要求的子宫颈高级别鳞状上皮内病变的治疗价值。方法回顾性分析2010年1月~2015年12月成都大学附属医院收治的152例子宫颈上皮内瘤变Ⅲ级（CIN Ⅲ级）患者的临床资料，根据手术方式的不同将其分为宫腔镜下宫颈“图钉形”切除术组（宫腔镜组）和宫颈冷刀锥切术组（CKC组），其中宫腔镜组患者70例，CKC组患者82例。比较两组手术时间、术中出血量、手术前后病理结果、手术疗效及随访情况、术后妊娠情况（妊娠率、流产率、早产率、阴道分娩率及剖宫产率）及术后满意度调查等指标变化。结果宫腔镜组患者的手术时间、术中出血量低于CKC组，差异有统计学意义（P < 0.05）。两组术后病理结果、随访薄层液基细胞学检查（TCT）异常及复发率比较，差异无统计学意义（P > 0.05）。两组患者的妊娠率、分娩方式比较，差异无统计学意义（P > 0.05）。宫腔镜组的早产率低于CKC组，差异有统计学意义（P < 0.05）。宫腔镜组患者住院时间、术后身体恢复、术后心理恢复及总体满意度评分均高于CKC组，差异有统计学意义（P < 0.05）。结论宫腔镜下“图钉式”宫颈锥切术手术时间短、术中出血少、术后妊娠早产率低，是有生育要求的子宫颈高级别鳞状上皮内病变患者的首选治疗方式，值得临床推广。

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	卢玉娟杨志玲▲ 王愚

关键词 ：子宫颈高级别鳞状上皮内病变, 宫腔镜, 宫颈&ldquo, 图钉形&rdquo, 切除术, 宫颈冷刀锥切术

Abstract：Objective To explore the value of hysteroscopic “pushpin” cervical resection in the treatment of high-grade cervical squamous intraepithelial lesions with fertility requirements. Methods Clinic data of 152 patients with cervical intraepithelial neoplasias (CIN) grade Ⅲ from January 2010 to December 2015 were retrospectively analyzed. According to the different surgical methods, they were divided into hysteroscopic “pushpin” cervical resection group (hysteroscopy group) and thecervical cold knife conization group (CKC group), including 70 patients in hysteroscopic group and 82 patients in CKC group. The changes of operation time, intraoperative blood loss, pathological results between postoperative and preoperative, operation effect and follow-up, postoperative pregnancy (pregnancy rate, abortion rate, premature delivery rate, vaginal delivery rate and cesarean section rate) and postoperative satisfaction were compared between the two groups. Results The operation time and intraoperative blood loss in hysteroscopy group were lower than those in CKC group, the differences were statistically significant (P < 0.05). There were no significant differences between the two groups in postoperative pathological results, TCT and recurrence rate (P > 0.05). There were no significant differences in pregnancy rate and delivery mode between the two groups (P > 0.05). The preterm delivery rate of hysteroscopy group was lower than that of CKC group, the difference was statistically significant (P < 0.05). The length of stay, postoperative physical recovery, postoperative psychological recovery and overall satisfaction score of the hysteroscopic group were all higher than those of the CKC group, the differences were statistically significant (P < 0.05). Conclusion The hysteroscopy has shorter operation time, less bleeding during operation and lower rate of preterm pregnancy after operation. It is the preferred treatment for fertility requirements with high-grade cervical squamous intraepithelial lesions and it is worthy of clinical promotion.

Key words： High-grade cervical squamous intraepithelial lesions Hysteroscopy Cervical “pushpin&rdquo resection Cold knife conization

基金资助:四川省卫生和计划生育委员会科研课题（150003）。

通讯作者: ▲通讯作者

引用本文:

卢玉娟杨志玲▲ 王愚. 宫腔镜下宫颈“图钉形”切除术治疗有生育要求的子宫颈高级别鳞状上皮内病变的临床探讨[J]. 中国医药导报, 2020, 17(15): 96-99.
LU Yujuan YANG Zhiling▲ WANG Yu. Clinical study on the treatment of cervical high-grade squamous intraepithelial lesionswith fertility requirements by hysteroscopic “pushpin” cervicalresection and cervical cold knife conization. 中国医药导报, 2020, 17(15): 96-99.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I15/96

[1] 郑荣寿，孙可欣，张思维，等.2015年中国恶性肿瘤流行情况分析[J].中华肿瘤杂志，2019，41（1）：19-28.
[2] Loopik DL，Doucette S，Bekkers RL，et al. Regression and progression predictors of CIN2 in women younger than 25 years [J]. J Low Genit Tract Dis，2016，20（3）：213-217.
[3] 谢幸，孔北华，段涛，等，妇产科学[M].9版.北京：人民卫生出版社，2018：295-298.
[4] H?觟ckel M，Dornhofer N. The hydra phenomenon of cancer：why tumors recur locally after microscopicallycomplete resection [J]. Cancer Res，2005，65（8）：2997-3002.
[5] 郑友红.女性胎儿生殖道上皮及肌层组织发育特点的基础研究[D].广州：南方医科大学，2016.
[6] 杨莉，黄鼎革，付建群.宫颈环形电切术治疗宫颈高级别鳞状上皮内病变的临床分析[J].江西医药，2019，54（12）：1602-1603.
[7] Zhuang H，Hong S，Zheng L，et al. Effects of cervical conisation on pregnancy outcome：a meta-analysis [J]. J Obstet Gynaecol，2018，39（1）：74-81.
[8] 赵晓丽，贾晓慧，王倩倩.宫腔镜下宫颈锥切术与宫颈冷刀锥切术治疗CINⅡ、Ⅲ级的效果对比观察[J].临床研究，2019，27（12）：87-89.
[9] 夏恩兰.宫腔镜手术并发症的过往及现状[J/CD].中华妇幼临床医学杂志：电子版，2016，12（3）：1-4.
[10] 陈孝平，张占国.层次解剖：再谈腹部外科这一古老的解剖概念[J].中华消化外科杂志，2016，15（1）：12-15.
[11] 刘金刚，谭晓东.图解外科手术—从膜的解剖解读术式要点[M].3版.沈阳：辽宁科学技术出版社，2013.
[12] 王袁，郑友红，王沂峰.宫颈病变手术术式与妊娠相关问题[J].实用妇产科杂志，2018，34（2）：93-95.
[13] 洪慧，公颜平，孟晔.宫颈冷刀锥切术对宫颈上皮内瘤变患者妊娠及妊娠结局的影响[J].安徽医药，2019，40（11）：1198-1200.
[14] Kyrgjou M，Valasoulis G，Stasionu SM，et al. Proportion of cervical excision for cervical intraepithelial neoplasia as a predictor of pregnancy outcomes [J]. Int J Gynaecol Obstet，2015，128（2）：141-147.
[15] Ford J H，Li M，Scheil W，et al. Human papillomavirus infection and intrauterine growth restriction：A data-linkage study [J]. J Matern Fetal Neonatal Med，2019，32（2）：279-285.
[16] Frega A，Santomauro M，Sesti F，et al. Preterm birth after loop electrosurgical excision procedure （LEEP）：how cone features and microbiota could influence the pregnancy outcome [J]. Eur Rev Med Pharmacol Sci，2018，22（20）：7039-7044.
[17] Champer M，Wong AM，Champer J，et al. The role of thevaginal microbiome in gynaecological cancer [J]. BJOG，2018，125（3）：309-315.
[18] Maguier PJ，Mccarthy CM，Molony P，et al. Large loop excision of the transformation zone and preterm delivery over a decade in a major women′s hospital [J]. Ir J Med Sci，2019，188（2）：579-581.
[19] Ciavattini A，Clemente N，DelliCarpini G，et al. Loop electrosurgical excision procedure and risk of miscarriage [J]. Fertil Steril，2015，103（4）：1043-1048.
[20] Jiang YM，Chen CX，Li L. Meta-analysis of cold-knife conization versus loop electrosurgical excision procedure for cervical intraepithelial neoplasia [J]. Onco Targets Ther，2016，9：3907-3915.doi：10.2147/OTT.S108832.