Vol.14, No 1, 2007 pp. 25 - 29
UC
618.146-006-089-085
THE RATIONALE FOR HYSTERECTOMY
AFTER UTERINE CERVIX CONIZATION
Vekoslav Lilić1, Zorica Stanojević2, Biljana Djordjević3, Radomir Živadinović1, Goran Lilić1
Clinical Center Niš, Serbia
1Clinic of Gynecology and Obstetrics
2Clinic of Oncology
3Clinic of Pathology
Summary.
Our aim was to investigate the incidence, most common indications and adequacy of hysterectomy after uterine cervix conization. We have retrospectively analyzed the patients with conization treated at the Clinic of Gynecology and Obstetrics in Niš from 2000 to 2004. There were 306 uterine cervix conizations performed in total. In 54 patients, on the average in 17.64% hysterectomy was done after conization. Out of all the indications for hysterectomy after conization, the most common was microinvasive and invasive uterine cervix carcinoma in 59.25% and positive conization margins in 27.77%. The analysis of histopathologic findings obtained at hysterectomy following conization demonstrated that hysterectomy was too extensive in 70,37% of the cases, since in 27.77% the findings were benign and in 42.59% of the cases cervical intraepithelial neoplasia (CIN) was identified, for which surgical reintervention would have been sufficient. In the cases of microinvasive and invasive carcinoma, hysterectomy (radical) was demonstrated to be adequate (and that is of statistical significance), since in 80% the findings were identical at hysterectomy. Conclusion. The most common indication for hysterectomy after conization is microinvasive and invasive uterine cervix carcinoma, immediately followed by positive conization margins. Hysterectomy is not an adequate surgical reintervention for positive conization margins, since in 70.37% of the cases it proved to be a too extensive surgery.
Key words:
Hysterectomy, conization, conization margins
OPRAVDANOST HISTEREKTOMIJE NAKON KONIZACIJE GRLIĆA MATERICE
Kratak sadržaj:
Cilj rada je da ispita učestalost, najčešće indikacije i opravdanost histerektomije nakon konizacije grlića materice. Korišćenjem retrospektivne metode analizirali smo bolesnice sa konizacijom, operisane na Ginekolo-akušerskoj klinici (GAK) u Nišu od 2000. – 2004. godine. Načinjeno je ukupno 306 konizacija grlića materice. Kod 54 bolesnice, prosečno u 17,64% je nakon konizacije urađena histerektomija. Najčešća indikacija za histerektomiju nakon konizacije je mikroinvazivni i invazivni karcinom grlića materice u 59,25% i pozitivne ivice konizata u 27,77% bolesnica. Analiza histopatoloških nalaza dobijenih na histerktomiji posle konizacije, kod bolesnica sa pozitivnim ivicama konizata, je pokazala da je histerektomija kao način lečenja bila preobimna za 70,37 % bolesnica, jer je u 27,77% nađen benigni nalaz, a u 42,59% cervikalna intraepitelna neoplazija (CIN) za koji bi rekonizacija bila dovoljna hirurška reintervencija. U slučaju mikroinvazivnog i invazivnog karcinoma histerektomija (radikalna) se pokazala kao statistički značajno adekvatnim načinom hiruške reintervencije jer je u 80 % nalaz bio identičan i na histerektomiji. Najčešća indikacija za histerektomiju nakon konizacije je mikroinvazivni i invazivni karcinom grlića materice i pozitivne ivice konizata . Histerektomija nije adekvatna hiruška reintervencija kod pozitivnih ivica konizata, jer je u 70,37% bila preobimna hiruška reintervencija.
Ključne reči:
Histerektomija, konizacija, ivice konizata
