Repeat conization in patients with residual or recurrent cervical intraepithelial neoplasia

向礼兵; 蔡祎品; 徐晓丽; 杨文涛; 吴小华; 王华英; 李子庭; 杨慧娟

doi:10.3969/j.issn.1007-3969.2013.05.009

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Repeat conization in patients with residual or recurrent cervical intraepithelial neoplasia

更新时间：2025-12-31

- Repeat conization in patients with residual or recurrent cervical intraepithelial neoplasia
- China Oncology Vol. 23, Issue 5, Pages: 370-374(2013)
- 作者机构：
  
  1. 复旦大学附属肿瘤医院妇瘤科，复旦大学上海医学院肿瘤学系,上海,200032
  2. 复旦大学附属肿瘤医院病理科，复旦大学上海医学院肿瘤学系,上海,200032
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.1007-3969.2013.05.009
  CLC：
- Published Online：19 November 2014，
  
  Published：2013
- 稿件说明：
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向礼兵,蔡祎品,徐晓丽,杨文涛,吴小华,王华英,李子庭,杨慧娟. 再次宫颈锥切术在处理残留或复发宫颈上皮内瘤变中的应用[J]. 中国癌症杂志, 2013, 23(5): 370-374.

向礼兵, 蔡祎品, 徐晓丽, et al. Repeat conization in patients with residual or recurrent cervical intraepithelial neoplasia[J]. China Oncology, 2013, 23(5): 370-374.
向礼兵,蔡祎品,徐晓丽,杨文涛,吴小华,王华英,李子庭,杨慧娟. 再次宫颈锥切术在处理残留或复发宫颈上皮内瘤变中的应用[J]. 中国癌症杂志, 2013, 23(5): 370-374. DOI： 10.3969/j.issn.1007-3969.2013.05.009.

向礼兵, 蔡祎品, 徐晓丽, et al. Repeat conization in patients with residual or recurrent cervical intraepithelial neoplasia[J]. China Oncology, 2013, 23(5): 370-374. DOI： 10.3969/j.issn.1007-3969.2013.05.009.

摘要

背景与目的：再次宫颈锥切可作为宫颈上皮内瘤变(cervical intraepithelial neoplasia，CIN)初次锥切后治疗失败患者的主要治疗手段之一，但很少有临床研究证实其有效性和安全性。本研究旨在评估再次宫颈锥切术在处理初次锥切术后切缘阳性患者或随访再次发现宫颈病变患者中的诊治价值。方法：2003年9月—2010年7月在复旦大学附属肿瘤医院妇瘤科因高级别CIN接受2次宫颈锥切术的患者共65例，包括50例首次手术切缘阳性患者和15例随访中再次发现宫颈病变患者。分析65例患者再次锥切标本的组织病理及切缘情况，随访观察再次术后并发症、术后妊娠以及病变复发情况。结果：50例首次手术切缘阳性的患者经再次锥切后，2例(4.0%)被证实为浸润性宫颈癌(腺癌Ⅰ

期和鳞癌Ⅰ

期各1例)，23例(46.0%)标本中存在残留的CIN病变。15例随访中再次发现宫颈病变的患者，11例(73.3%)被证实存在CIN病变。再次锥切后58例患者切缘阴性(89.2%)，7例(10.8%)患者切缘阳性(包括1例宫颈腺癌和6例CIN)。5例患者因发现宫颈浸润癌或2次锥切切缘阳性或术后并发症而补充行子宫切除术。另有2例发生严重并发症(1例术中大出血，1例术后宫颈创面大出血)的患者经保守处理后好转。在保留子宫的60例患者中，中位随访时间为41个月(25~87个月)，4例(6.7%)患者被发现有CIN病变复发。结论：再次锥切术可以切除残留或复发的宫颈病变组织而保留生育功能，并有可能发现首次手术未被发现的浸润性癌；严重的手术并发症很少见，但需要积极预防。

Abstract

Background and purpose: Repeat conization is a conservative surgical choice for the treatment failure after primary conization in patients with cervical intraepithelial neoplasia (CIN)

however

there were limited evidences to show its efficacy and safety. The aim of the present study was to evaluate the treatment and diagnostic value of repeat conization in the management of residual or recurrent CIN. Methods: From 2003 to 2010

65 CIN patients underwent repeat conization for positive margin

persistent or recurrent disease after primary conization in Fudan University Shanghai Cancer Center. The medical records and pathological slides were reviewed on histopathological outcomes

margin involvement

complications during and after repeat conization

and reappearance of CIN lesions during follow-up

as well as obstetric outcomes. Results: Among the 50 patients for the treatment of positive margin after primary conization

invasive carcinoma was confirmed in 2(4.0%) patients (1 adenocarcinoma and 1 microinvasive squamous carcinoma)

and residual CIN lesions were present in 23 patients (46.0%). In the rest 15 cases for the treatment of persistent or recurrent disease after primary conization

11(73.3%) patients had CIN lesions in the cone specimens

none had invasive carcinoma. After the secondary conization

58 patients had clear margins. Involvement of the ectocervical or endocervical margins was found in 1 adenocarcinoma case and 6 CIN cases. Additional hysterectomy was carried out in the adenocarcinoma case

3 cases with positive margin and 1 case with cervical occlusion and amenorrhea because of cervical adhesion. Massive hemorrhage was another severe complication and occurred in 2 cases. In the 60 cases who preserved their uteruses after secondary conization

reappearance of CIN disease was documented in 4 (6.7%) cases during the median follow-up of 41 months (25-87). Conclusion: Repeat conization appears to be a rational treatment choice for young patients with residual

persistent

recurrent CIN. Invasive carcinoma could be revealed in the repeat conization. Severe complication was uncommon

but needs active management.

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