宫颈上皮内瘤样病变在宫颈分布特征的研究

Study on distribution of cervical intraepithelial neoplasia in uterine cervix

目的:寻找宫颈上皮内瘤样病变(CIN)在宫颈的分布特征。方法:通过对575例CIN行宫颈锥切术后的组织病理学结果进行回顾性分析,将宫颈按最常见的点、发病最重的点、每个象限和象限的组合进行研究,寻找CIN在宫颈各部位的分布特征以及年龄组、HPV感染的分布特点并比较其差异。结果:575例中CIN1为146例,≥CINⅡ为429例。CIN主要分布在30～39岁年龄段,与其他年龄组相比差异有统计学意义(P<0.05)。宫颈病变的发病率伴随HPV阳性率高达92.72%,两者有非常显著的相关性(P<0.01)。在146例CINI和429例≥CINII两组病变中,均是12点出现的频次最高,分别为43.84%和37.06%;2点最低,分别为33.57%和27.74%,差异有统计学意义(P<0.05)。在两组病变中,CINI组病变最重点以8点出现频次最高(12.33%),≥CINII组病变最重点以7点频次最高(11.42%),两组均是2点最低分别为2.74%和4.43%,差异有统计学意义(P<0.01)。第2、3、4象限发病率与第1象限差异有统计学意义(P<0.01)。在146例CINI和429例≥CINII两组病变中,宫颈后唇分布分别为58.22%和54.55%,均比前唇41.78%和45.45%多见(P<0.01),宫颈右侧分别为54.79%和56.18%均比左侧45.21%和43.82%多见(P<0.05)。结论:要加强30～39岁年龄段和HPV阳性CIN患者的管理。CIN患者临床活检时,从病变某点分布上要重视对12、8和7点的取材,从病变象限分布上要重视宫颈后唇和右侧的取材,以提高CIN的活检率和临床诊治率。

Objective： To find the distribution characteristics of cervical intraepithelial neoplasia （CIN） in uterine cervix. Methods： The pathological results of 575 cases with CIN after cervical conization were analyzed retrospectively. The most common locations, the most severe locations, the characteristics of quadrants, the distribution of age and HPV infection were studied. The differences were compared. Results： Among 575 cases, 146 cases with CIN1 and 429 cases with ≥ CIN2 group were included. The ineidenee rate of CIN was the highest in 30- 39 -year- old group, compared with the other age groups, there was statistically significant difference （P〈 0. 05 ） . HPV infection was found positive in 92.72% of CIN patients. In CIN1 and ≥CIN2 cases, the most common location was 12 oi.l.ek spot （43.84%） and 12 oclock spot （37.06%）, respectively; the least common locations was 2 o＇clock spot （33.57%） and 2 o＇clock spot （27. 74% ）, respectively （P 〈 0. 05 ） . In CIN1 group, the most severest lesion showed up at 8 o＇clock spot with the highest frequency （ 12. 33% ） and at 2 o＇clock spot with the lowest frequency （2. 74% ） ; in ≥CIN2 group, the most severest lesion showed up at 7 o＇clock spot （ 11.42% ） and at 2 o＇clock spot with the lowest frequency （4. 43% ） （P 〈0. 01 ） . Compared with other quadrants, the ineidenee rate was the lowest in the first quadrant （P 〈 0. 01 ） . Lesions was found more common on the posterior （58.22% and 54. 55%, respectively） than anterior （41.78% and 45.45%, respectively）, and on the right side （54. 79% and 56. 18%, respectively） than the left side （45.21% and 43.82%, respectively） in the two groups （P 〈 0. 05） . Conclusion： Management of CIN patients with positive HPV and women aged 30 -39 years old should enhanced. When cervical biopsy is conducted, 12, 8 and 7 o＇clock spots and on posterior and right side of cervix should be alerted to improve biopsy rate and clinical diagnosis and treatment.