高级别宫颈上皮内瘤变临床特点与诊治分析

Clinical Characteristics,Diagnosis and Treatment of Patients with High-Grade Cervical Intraepithelial Neoplasia

[目的]分析高级别宫颈上皮内瘤变(CIN)患者的临床及诊治特点,评估彩超、术中冰冻(FSE)的诊断价值。[方法]回顾性分析经手术治疗的CIN2/3患者的临床病理资料,分析术前、术中、术后病理分级转化及手术治疗情况。[结果]①CIN2/3患者的流产率(73.91%)、恶性肿瘤家族史比例(32.02%)均高于正常对照组,与CIN的发生呈正相关。②58.89%(149/253)的CIN2/3病例彩超表现为宫颈回声异常。③FSE漏诊宫颈癌77.33%,未提高高级别CIN的诊断符合率,与PSE一致性较差(Kappa=0.217,P<0.001)。[结论]高流产率、恶性肿瘤家族史可能与CIN发生有关。彩超对高级别CIN有辅助诊断价值。FSE对术中决策有一定价值,但依据FSE指导手术存在风险。高级别CIN的治疗应避免治疗过度/不足。

[Purpose] To analyze the clinical characteristics of patients with high-grade cervical in- traepithelial neoplasia （CIN）,and to evaluate the diagnostic value of ultrasound and intraoperative frozen（FSE）. [Methods] The clinicopathological data of CIN2/3 patients after operative treatment were analyzed retrospectively. Preoperative,intraoperative and postoperative pathological grade trans- formation and surgical treatment were analyzed. [Results] ①The abortion rate （73.91%） and family history of cancer incidence（32.02%） in patients with CIN2/3 were higher than those in control group, and positively correlated with CIN.②Uhrasound showed 58.89%（149/253） patients with abnormal cervical echo. ③The missed diagnosis rate of FSE for cervical cancer was 77.33%, and did not im- prove the diagnostic accuracy of high-grade CIN. The concordance between FSE and PSE was low （kappa=0.217, P〈0.001）. [ Conclusion ] High abortion rate,family history of cancer might be associat- ed with the occurrence of CIN. The color Doppler ultrasound has assistant diagnostic value to high- grade CIN. FSE has some value for intraoperative strategy,but there is a risk to be used it as an in- dicator to guide operation. High-grade CIN treatments should avoid over-treatment and inadequate treatment.