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高级别宫颈上皮内瘤变的临床诊治分析 被引量:14

Clinical Analysis of Diagnosis and Treatment of High-Level Cervical Intraepithelial Neoplasia
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摘要 目的:评价液基薄层细胞学(TCT)检查、阴道镜活检病理和宫颈冷刀锥切术(CKC)在高级别宫颈上皮内瘤变(CIN)诊断中的价值,并分析CKC及子宫全切术治疗高级别CIN的效果。方法:收集2007年1月至2012年1月行TCT检查、阴道镜下活检、CKC或子宫全切术后的高级别CIN患者的临床病理资料,对比分析手术前后诊断及不同治疗手段的CIN病理分级转化及复发情况。结果:术前TCT检查及阴道镜活检病理诊断高级别CIN376例,其中保留生育功能及子宫的248例,均行CKC(CKC组);行子宫全切术128例(子宫全切术组)。CKC组与子宫全切术组术后病理检查与术前阴道镜活检病理诊断CIN分级一致率、上升率和下降率分别为52.02%,45.31%;3.23%,1.56%和44.76%,53.13%,两组比较差异均无统计学意义(P>0.05)。两组平均随访28个月,CKC组复发6例(2.42%),子宫全切术组复发1例(0.78%),差异无统计学意义(P>0.05)。结论:TCT是筛查高级别CIN的有效方法;单独阴道镜下活检病理诊断高级别CIN的准确性尚不够理想,不能替代CKC后病理检查。对年轻要求保留生育功能的高级别CIN患者,CKC安全有效;对无生育要求的中老年患者全子宫切除是较好的方法。 Objective:To evaluate the efficiency of thinprep cytologic test(TCT) ,colposcopically directed biopsy pathology,and cold knife conization (CKC)in the diagnosis of high-level cervical intraepithelial neoplasia (CIN), and to compare the efficiency of CKC and hysterectomy in the treatment of high-level CIN. Methods:The clinical pathologic data of the patients who took TCT,colposcopically directed biopsy pathology,CKC and the hysterectomy in our hospital from January,2007 to January,2012 were retrospectively analyzed, the preoperative/postoperative diagnosis, treatment and the pathology grade transformation were com- paratively analyzed. Results :376 cases of high-level CIN were diagnosed by the TCT and colposcopically directed biopsy, in which 248 cases keeped reproductive function and uterus were treated with CKC (CKC group) ,and 128 cases were treated with hysterectomy( hysterectomy group). There was no significant difference in the frequency of unchanged pathology, upgrade pathology and downgrade pathology between CKC group (52.02% ,3. 23% and 44. 76%, respectively) and hysterectomy group (45.31%,1.56% and 53. 13% respectively). Both two groups received 28-month follow-up, there were 6 (2.42%) recurrent cases who were treated by CKC and 1 (0.78%) recurrent case who undertake hysterectomy,and the difference was not significant( P 〉0.05). Conclusions: TCT is an effective method for screening high-level CIN. Single colposcopicaUy directed biopsy pathology is not completely accurate in the diagnosis of high level CIN and it cannot take place of the pathology of postoperative CKC. For the Young patients of high-level CIN with desire of fertility, the CKC is a safe and effective method for the treatment of high level CIN. For the elderly patients without desire of fertility, hysterectomy is a better treatment method.
出处 《实用妇产科杂志》 CAS CSCD 北大核心 2013年第2期140-144,共5页 Journal of Practical Obstetrics and Gynecology
关键词 液基薄层细胞学 阴道镜 宫颈上皮内瘤变 宫颈冷刀锥切术 子宫全切术 Thinprep cytologic test Colposcopically directed biopsy Cervical intraepithelial neoplasia Cold knife conization ~ Hysterectomy
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