高级别宫颈上皮内瘤变的临床诊断治疗分析

孙晓燕

【摘要】 目的 评价TCT检查、阴道镜活检和宫颈冷刀锥切术（CKC）在高级别宫颈上皮内瘤变（CIN）诊断中的价值， 并比较CKC及子宫全切术治疗高级别CIN的效果。方法 收集2007年1月～2012年1月TCT、阴道镜下活检、CKC或子宫全切术后病例的临床病理资料， 对不同诊治手段和CIN病理分级转化进行对比分析。结果 经TCT、阴道镜活检病理证实高级别CIN 376例， 行CKC 248例， 行子宫全切术128例， CKC与全切术前与术后分级一致率、分级上升率和分级下降率分别为52.02%，45.31%，3.22% ， 1.56%， 44.76%，53.13%。两组患者平均随访2年， CKC 248例复发6例（2.42%）， 子宫全切128例复发1例（0.78%）， 差异无统计学意义（P=0.2500）。结论 TCT和阴道镜活检是诊断高级别CIN的有效手段， 对年轻要求保留生育功能的高级别CIN患者， CKC是安全且有效的方法， 对无生育要求的中老年高级别CIN患者全子宫切除是最好的治疗方法， 两种术式两年复发率差异无统计学意义。

【关键词】 TCT；阴道镜；高级别宫颈上皮内瘤变；宫颈冷刀锥切术；子宫全切术；病理学；随访；复发

【Abstract】 Objective To evaluate the significance of the check of TCT， colposcopically directed biopsy and cold knife conization（CKC）in diagnosis of high-level cervical intraepithelial neoplasia （CIN）， and to compare the effects of different Methodsof the CKC and the hysterectomy. Methods The TCT， colposcopically directed biopsy， CKC and the hysterectomy from January，2007 to January， 2012 were collected， and the different diagnosis and treatment Methodsand the pathology grade transformation were comparatively analysed. Results 376 cases of high-level CIN were diagnosed by the TCT， colposcopically directed biopsy.248 cases were treated with CKC， and 128 cases were treated with hysterectomy. The frequency of unchanged pathology， upgrade pathology and downgrade pathology were 52.02%，3.22% and 44.76% in CKC group， while 45.31%，1.56% and 53.13% in hysterectomy group. Two groups received 2-year follow-up， there were 6（2.42%） recurrent cases who were treated by CKC.Hysterectomy patients found 1（0.78%） recurrent case. Relapse rate compared two groups of patients， the difference was not statistically significant， P=0.2500. Conclusion TCT and colposcopically directed biopsy are effective assisting method for diagnosing high-level CIN.Recommendations and requirements for the retention of young patients of reproductive function in patients with high-level CIN should receive CKC. The CKC is a safe and effective method. To barren requirements of the elderly high-level CIN， hysterectomy is the best treatment method， the recrudescence rate of two years between two kinds of operation showed not statistically different.

【Key words】 TCT； Colposcopically directed biopsy； High-level CIN； Cold knife conization（CKC）； Hysterectomy； Pathology； Follow-up； Recurrence

宫颈上皮内瘤变（CIN）是与浸润性宫颈癌密切相关的一组癌前病变， 分为CINⅠ、Ⅱ、Ⅲ级，而CIN的级别越高，其消退和逆转的机会越小，所以尽早发现和治疗高级别CIN对减少宫颈癌的发生至关重要。现选择TCT异常，多点活检为高级别CIN收治行宫颈冷刀锥切术或子宫全切术的376例患者进行回顾性分析及术后随访， 报告如下。

1 资料与方法

1. 1 一般资料 2007年1月～2012年1月到本院妇科就诊患者， 主诉阴道分泌物量多、接触性出血等， 妇科检查宫颈炎， 液基细胞学异常， 行阴道镜下活检， 证实有高级别CIN的患者376例， 入院行CKC治疗248例， 行子宫全切术治疗128例。……