宫颈上皮内瘤样病变的临床研究

Clinical study of cervical intraepithelial neoplasia

目的比较宫颈上皮内瘤样病变（CIN）行宫颈锥切术后或全子宫切除术后病理结果与术前阴道镜下宫颈多点活检病理结果及两种术式的治疗效果。方法对收治的72例CIN患者进行回顾性分析,采用自身对照法比较宫颈在阴道镜下多点活检与宫颈锥切术后或全子宫切除术后的病理检查结果。结果 72例患者中有51例行宫颈锥切术,其中有28例CINⅢ术后病理分级与术前阴道镜下多点活检结果一致,符合率为72.50%,锥切术后有1例由CINⅡ升级为CINⅢ,总的升级率为3.92%;锥切术前、术后CINⅡ、CIN I病理结果一致的分别有1例和5例,因此总符合率66.67%;锥切术后病理分级降级：CINⅢ级11例,CINⅡ级3例,CINⅠ级1例,降级率为29.41%。本组有21例患者因患者个人因素、无生育要求或合并其他疾病等直接行全子宫切除术。子宫切除术后病理结果与术前病理分级相符合共11例CINⅢ级,1例CINⅡ级,1例CINⅠ级,因此CINⅢ级的符合率和总符合率分别为57.89%和61.90%。两种术式的术前术后病理结果在CINⅢ级符合率、总符合率、总升级率和总降级率方面,均无统计学差异（P〉0.05）。所有患者随访6-12个月,均未见复发。结论对于宫颈上皮内瘤样病变,选择全子宫切除术或宫颈锥切术,其对术前病理结果的影响不大,两种术式都是宫颈上皮内瘤样病变患者的合理选择。

Objective To compare the histopathological results and treatment outcome between cervical conization / complete hysterectomy and preoperative multiple point biopsy for patients with cervical intraepithelial neoplasia（ CIN）. Methods Seventy-two patients with CIN disease were enrolled into this retrospective study. A comparison of histopathological results between preoperative multiple point biopsy and cervical conization or complete hysterectomy was made through self-controlled method. Results Fifty-one patients underwent cervical conization,of whom 28 patients with CIN III disease had identical pathological findings between hysterectomy and multiple point biopsy（ coincidence rate,72. 50%）. After surgery,1 patient was upgraded from CIN II to CIN III. Overall upgrading rate was 3. 92%. One patient with CIN II disease and5 patients with CIN I disease had identical pathological findings between pre-and post-cervical conization,respectively,and the overall coincidence rate was 66. 67%. Downgrade after cervical conization occurred in11 patients with CIN III,3 patients with CIN II,and 1 patient with CIN I. The overall downgrading rate was29. 41%. Of all patients,21 patients underwent complete hysterectomy due to personal reason,no need of fertility,or comorbidities. Eleven patients with CIN III,1 patient with CIN II,and 1 patient with CIN I had identical pathological findings between pre-and post-hysterectomy,thus coincidence rate in CIN III was57. 89%,and overall coincidence rate was 61. 90%. With regard to coincidence rate in CIN III,overall coincidence rate,overall upgrading rate,and overall downgrading rate,the two surgical approaches had no significant differences in pathological results between pre- and post-operation（ P〉0. 05）. The follow-up time was 6- 12 months,and no patient experienced recurrence. Conclusion For patients with CIN disease,either complete hysterectomy or cervical conization had no significant impact on pre-operative pathological findings. The two surgical approaches are appropriate for these patients.