宫颈上皮内瘤样病变的诊治探讨

Analysis of Diagnosis and Treatment for Patients with Cervical Intraepithelial Neoplasia

【目的】探讨宫颈上皮内瘤变的最佳诊断和治疗方法,以达到减少漏诊,减少术后病变残留、复发的目的。【方法】对2003年12月至2005年1月采用宫颈液基细胞学、高危HPV检测、阴道镜检查筛查出宫颈上皮内瘤变302例。根据病变不同程度和生育要求,行宫颈电灼术、电环切除、全子宫切除,对其疗效作回顾性分析。【结果】细胞学检查存在着假阴性率15.2%。高度上皮内瘤变约97.6%高危HPV阳性,低度上皮内瘤变中88.2%高危HPV阳性。行电环切除术196例,术后病理为阴性的49例,病变仍有CIN,但期别减轻者64例,升级者18例,相同者65例。LEEP术后排除浸润癌,再行子宫切除,子宫标本未发现浸润癌。电灼和电环切除术后并发症少,随访最长18个月没有复发。【结论】细胞学结合HPV检查可减少宫颈上皮内瘤变的漏诊率,根据期别和生育要求对宫颈上皮内瘤变行宫颈电灼和电环切除术可获得满意疗效。

[Objective] To investigate the best diagnosis and treatment for Cervical Intraepithelial Neoplasia（CIN） for reducing the number of misdiagnoses,postoperative recurrence and residual focus of pathological change. [Methods]From Dec 2003 to Jan 2005, 302 cases of Cervical Intraepithelial Neoplasia were discovered by cervical thin-prep cytology test, high risk human papillomavirus inspections and colposcopic inspections. In accordance with level of pathological change and requirement of procreation, cervical fulguration,loop electrosurgical excision procedure（LEEP） total hysterectomy had been employed, results were analyzed retrospectively. [Results]A false negative rate of cytology was 15. 2%. Highgrade squamous intraepithelial neoplasia showed about 97.6% HPV positive, low-grade one showed 88.2% HPV positive. LEEP was used in 196 patients, 49 patients recovered, 64 patients had pathological change with CIN but stage reduced. The postoperative diagnosis was downgraded in 18 cases ,65 patients remained the same. Postoperation of LEEP excluded invasive cervical cancer, then the wombs were excised, no invasive cervical cancer was found in the sample of womb. There were less complications after fulguration and LEEP. there was no relapse within 18 months. [Conclusion]Combination of cytology and HPV check-up can reduce the number of missing diagnosis of Cervical Intraepithelial Neoplasia. According to achieved by using cervical fulguration and thelial Neoplasia. stage and the requirement of procreation , satisfactory results can be Loop Electrosurgical Excision Procedure to treat Cervical Intraepithelial Neoplasia.