宫颈锥切术联合冰冻病理在CIN Ⅲ诊治中的应用

The application of conization of cervix combined with intraoperative frozen section examination in treatment of CIN Ⅲ

目的探讨宫颈锥切术联合术中冰冻病理在宫颈上皮内瘤变3级(CINⅢ)患者的诊断和治疗中的应用价值。方法对54例阴道镜下活检结果提示CINⅢ行宫颈锥切术并术中行冰冻切片检查的结果进行分析。结果宫颈锥切术中及术后病理结果,与阴道镜下多点活切的符合率70.37%(38/54);4例(7.41%)升级:早期浸润癌(Ⅰa1期)1例、浸润癌3例;12例(22.22%)降级,包括CINⅡ6例、CINⅠ4例、宫颈慢性炎2例。54例中切缘阳性5例(9.26%),其中切缘CINⅢ的3例患者,术中转开腹行全子宫切除术,另2例切缘阳性患者(切缘分别为CINⅡ1例、CINⅠ1例)因有生育要求等原因要求保守处理,未再次手术,随诊中发现CIN病灶自然消退;术中病理升级:1例宫颈早期浸润癌Ⅰa1期,术中转开腹行全子宫切除术,浸润癌3例行广泛全子宫切除术加盆腔淋巴结清扫术,术后病理切缘及淋巴结均阴性;切缘阴性45例(83.33%),均于术后定期随访,宫颈细胞学检查未见异常。结论宫颈锥切术联合术中冰冻病理能提高宫颈病变诊断准确性,为临床选择恰当的治疗方式提供依据,避免漏诊宫颈浸润癌;对于有保留生育功能的要求的CINⅢ年轻患者,宫颈锥切术是治疗的有效方法。

Objective To evaluate the value of application of conization of cervix combined with intraoperative frozen section examination in treatment of CIN Ⅲ diagnosed under colposcopy. Methods A retrospective analysis of the clinical data was carried out in 54 cases with CIN Ⅲ underwent conization of cervix from January 2004 to December 2008,and all patients had pathological diagnosis under colposcopy multiphase biopsy. Results 38 cases （ 70. 37%） were diagnosed with CINIII in accordance with freeze pathology and histopathology diagnosis; 4 （ 7. 41%） upgrades. including 1 case of early invasive carcinoma（ Ⅰa1） and 3 cases of invasive carcinoma had invasive carcinoma; 12 cases（ 22. 22% ） downgrades,including 6 cases of CINⅡ,4 cases of CINⅠand 2 cases of inflammarion. 5 cases （ 9. 26% ） had positive margins,three positive margins of patients with CIN Ⅱ objected to expectant treatment without breed demand. during operation,operated hysterectomy. another 1 of CIN Ⅱ,1 of CIN Ⅰ regressed to normal during follow-up. During operations,1 case of cervical cancer Ial operated hysterectomy,3 cases with invasive carcinoma of cervix had done extensive hysterectomy and pelvic lymph node dissection,pathological margin and lymph nodes were negative,In 45 cases （ 83. 33% ） with negative margin,no cytology abnormality was detected during follow-up. Conclusion Combined with intraoperative frozen section examination can improve the diagnosis of CINⅢ,choose the appropriate surgical method provide the basis for clinical,and avoid the missed diagnosis,and which is an effective treatment to CINⅢ with breed demand.