10年间宫颈上皮内瘤变手术患者临床资料分析

Retrospective Analysis of Cervical Intraepithelial Neoplasia Surgery in Recent 10 Years

目的：探讨10年间宫颈上皮内瘤变（CIN）手术患者的年龄变化趋势、相关影响因素以及诊治情况。方法：回顾性分析2004年1月—2013年12月于青岛大学附属医院妇科行手术治疗且资料完整的2 192例CIN患者的临床资料,了解其年龄变化、生育情况、高危型人乳头瘤病毒（HR-HPV）感染、术式的选择、术后与术前病理的符合率,对CIN的发病情况、影响因素及诊治方法进行分析。结果：110年间因CIN手术患者总数呈上升趋势,占妇科手术患者数量的比例日益增加,30~40岁为高发年龄;近5年无生育史患者明显多于前5年,差异有统计学意义（P〈0.001）。2621例患者行HPV DNA分型或定量检测,总感染率为95.65%,其中以HPV16阳性率最高,其次为HPV58、HPV52,43.09%的患者为HPV多重感染;CINⅢ组、宫颈癌ⅠA1及以上组HPV的感染率明显多于CINⅡ组,差异有统计学意义（P〈0.05）,而CINⅢ组、宫颈癌ⅠA1及以上组之间HPV感染率差异无统计学意义（P〉0.05）。3术后病理与术前宫颈活检病理符合率为76.73%。4CINⅡ及以上患者首选宫颈冷刀锥切术治疗者占75.27%。结论：CIN患者逐年增多,总体呈上升趋势,未生育的年轻患者逐渐增多,HR-HPV感染与CIN密切相关,冷刀锥切术为CINⅡ及以上患者的首选治疗方法。

Objective： To analyze retrospectively the age tendency, the related factors and the diagnosis and treatment in those patients with cervical intraepithelial neoplasias （CIN） in recent 10 years. Methods：A total of 2 192 patients with CIN, who had a surgical treatment, in our hospital from January 2004 to December 2013 were retrospectively analyzed. The clinical data were collected including the age ,pregnant history, HR-HPV infection, operation style, the rate of pathological coincidence between postoperation and preoperation, so as to analyze the incidence of CIN, risk factor and treatment method. Results： ①In the recent 10 years,the number of CIN patients increased year by year and the proportion of CIN in all surgical patients of gynecology also steadily increased. The age between 30 and 40 years was of high risk. The number of CIN patients without pregnancy in latter five years was more than that in front five years （P〈0.001）. ②In 621 patients received HPV test, the infection rate was 95.65%, and the positive rate of HPV16 was the highest,followed by HPV58 and HPV52. The infection rate of multiple HPVs was 43.09% in those positive patients. The infection rates of HPV in the CIN Ⅲand cervical cancerⅠA1 groups were significantly higher than that in the CINⅡ group （P〈0.05）. There was significant difference in the infection rates of HPV among the CINⅢ group,the cervical cancerⅠA1 group and the groups of higher-grading cervical cancer （P〉0.05）. ③The rate of pathological coincidence between postoperation and preoperation was 76.73%.④75.27%of patients with CINⅡand higher-grading cervical lesions were treated with cold knife conization （CKC） as the primary surgical procedure. Conclusions：The incidence of CIN was increasing year by year,especially in those young women without pregnancy. The infection of HR-HPV is closely related to CIN. The CKC is of choice surgical treatment for those patients with CIN Ⅱ and higher-grading cervical lesions.