A Comparison in Margin Status and Residual Lesion between Loop Electrosurgical Excision Procedure and Cold Knife Conization

比較線圈電切術及以刀片行子宮頸錐狀切片手術之檢體邊緣狀況及殘存病灶

陳子和(Tze-Ho Chen) ； 葉坤土(Kun-Tu Yeh) ； 許瑞昌(Ruey-Chang Hsu) ； 葉光芃(Guang-Peng Yeh) ； 周邦新(Pan-Hsin Chou)

《The Changhua Journal of Medicine》 6卷4期 (2001/10) Pp. 219-225

摘要

目的：比較經由線圈電切術或者傳統刀片所進行之子宮頸錐狀切片手術，在檢體邊緣狀態以及隨後切除之子宮當中有否殘存病灶，是否因手術方式的不同而有差異之處。
方法：185位接受線圈電切術及155位接受一般刀片錐狀切片手術的患者，這340位患者都在術後的六個月內再次接受子宮全切除手術治療。切除之子宮均送交組織病理檢查是否有殘存之子宮頸上皮病變，並藉以和先前的錐狀切片手術檢體邊緣狀態相互比較。
結果：錐狀切片組織的直徑和深度方面，刀片切除明顯較線圈電切術切除者來得寬且深。在子宮頸錐狀切片的檢體中81.1%線圈電切術的檢體及51.0%刀片切除的檢體邊綠有上皮病變組織。在接下來的子宮切除術檢體中線圈電切組有49.2%，刀片切除組有37.6%看到殘餘的病變組織。在所有錐狀切片檢體邊緣有病變組織的患者當中，線圈電切組150人有84人(56%)在接下來的子宮切除檢體中看到殘餘的病變組織，刀片切除組則是80人中有53人(66%)。在錐狀切片檢體邊緣有病變的患者當中，停經後的患者比停經前的患者更常在子宮切除檢體中殘餘有病變組織，線圈電切組是70.9%及47.4%，刀片切除組是71.4%及63.5%。至於在錐狀切片檢體邊緣有病變組織以及子宮殘餘的病變組織機率則和子宮頸上皮病變的程度或是否已經出現顯微侵犯無關。
結論：1)線圈電切術比起傳統刀片子宮頸錐狀切除對於子宮頸上皮病變的移除效果較差，但就診斷上而言則效果相當。2)子宮內殘存病變組織與否和錐狀切除之檢體是否有病變組織高度相關，但和上皮病變的程度較無關聯。3)接受線圈電切術的停經後患者較容易於子宮內發現殘餘的子宮頸上皮病變組織。

關鍵字

錐狀切片 ； 線圈電切術 ； 子宮頸上皮病變 ； 子宮檢體殘存病灶

並列摘要

Objective: The purpose of this study was to determine if there is any difference between cold knife conization (CKC) and loop electrosurgical excision procedure (LEEP) in regard to margin status and outcome in subsequent hysterectomy.
Methods: 185 patients received LEEP conization and 155 patients received cold knife conization. All 340 patients underwent subsequent hysterectomy within 6 months after cervix conization. The hysterectomy specimen was evaluated for residual CIN lesions and compared with the conization margin status.
Results: The mean diameter and the depth of the conization tissue were larger in the CKC than the LEEP conization. In the LEEP specimens, 81.1% showed conization margin involved by CIN lesions. In the CKC specimens, 51.0% showed this change. Residual CIN lesions were found in 49.2% and 37.6% of subsequent hysterectomy specimens in the LEEP and CKC groups respectively. In the conization specimens that showed a positive margin, residual lesions were found in 84 out of 150 (56%) and 53 out of 80(66%) in subsequent hysterectomy in the LEEP and CKC groups respectively.
The specimens in which conization margin was positive showed more residual lesions in postmenopausal than pre-menopausal patients, 70.9% vs. 47.4% in the LEEP group and 71.4% vs. 63.5% in the CKC group. The prevalence of margin involvement or residual lesion showed no statistical difference between CIN patients and microinvasive cancer patients in both the LEEP and CKC groups.
Conclusion: 1) LEEP is less effective than CKC in the ablation of CIN or microinvasive SCC lesions (P＜0.001) but as effective as CKC in diagnosis. 2) The residual lesion is highly associated with the conization margin status (P＜0.001) but not significantly associated with the severity of CIN or microinvasive cancer lesions. (3) More often residual lesions were found in subsequent hysterectomy in postmenopausal women than in premenopausal patients after LEEP conization (P=0.005).

並列關鍵字

Conization ； LEEP ； CIN ； residual lesions in hysterectomy specimens