128例湿热型宫颈上皮内瘤变手术患者临床相关问题探讨

Clinical Exploration on 128 Operative Cases with Cervical Intraepithelial Neoplasia Due to Damp-heat Pathogens

目的通过对128例湿热型宫颈上皮内瘤变(CIN)手术患者临床资料的回顾性分析,探讨该病湿热型患者的发病因素、诊治策略以及预防措施。方法收集2007年1月至2016年7月128例湿热型CIN住院手术患者的临床资料,采用统一表格记录,对患者症状、体征、检测指标、手术方式、病理结果及发病相关因素等进行统计分析。结果本病证患者好发年龄在30~50岁之间,临床以带下异常、性交出血、月经失调症状为主,占75.0%;中医辨证以湿热证型为主,多兼夹肾虚、脾虚、肝郁及瘀血证;宫颈检查以肥大合并糜烂者多见,占77.3%,外观无异常者占10.2%;人乳头瘤病毒(HPV)阳性者中以16/18型多见,定量值的大小与病变轻重程度无明显相关性;手术前后病理结果一致者占50.8%,病变程度上升者占29.7%,下降者占19.5%,术后原位癌或早浸癌的发现率较术前上升了5.4%。结论湿热型CIN有一定的临床特殊性,其发病与患者过早性生活、多个性伴侣、宫颈阴道慢性炎症等因素致免疫功能下降后HPV感染相关;宫颈冷刀锥切术在避免本病误诊、漏诊、术后大出血及避免其他手术热电效应干扰病理诊断等方面具有优势。正确认识本病的特殊性、选择恰当的手术方式局部和整体治疗、预防复发至关重要。

OBJECTIVE To explore the pathogenic factors, diagnosis and treatment strategy and preventive actions via per- forming a retrospective analysis of 128 operative cases with cervical intraepithelial neoplasia（CIN） due to damp-heat pathogen. METHODS Clinical data of the 128 cases hospitalized for CIN surgery due to damp-heat from January, 2007 to July, 2016, in- eluding the symptoms, signs, testing indexes, choice of operation, pathological results as well as relevant pathogenic factors, were recorded on the same chart and analyzed. RESULTS The disease was more likely to happen to females in their 30s to 50s, mainly manifested as the abnormal vaginal discharge, postcoital bleeding, menstrual disorder, accounting for 75%. It is generally classified as the type of damp-heat, accompanied with kidney deficiency, spleen deficiency, liver stagnation and blood stasis after syndrome differentiation in traditional Chinese medicine. 77.3 % of the patients experienced cervical hypertrophy to- gether with cervical erosion according to the tests, while still 10.2%of them had no abnormal appearance. The positive result of human papilloma virus （HPV） was mainly seen as 16 / 18, while its quantitative value had little to do with the with the se- verity of disease. 50.8% of the patients got the same pathogenic results before and after surgery, 29.7% experienced an exac- erbation after operation and 19.5% experienced an improvement. The discovery rate of carcinoma in situ or early invasive carci- noma after surgery went up by 5.4% than before. CONCLUSION CIN due to damp-heat has certain clinical specificities, whose occurrence is correlated to HPV infection arising from decreased immune function after premature sexual life, multiple sexual partners and chronic inflammation of cervix and vagina. Cervical cold knife conization has advantages in avoiding the misdiagnosis, missed diagnosis, postoperative massive hemorrhage and interferences of pathologic diagnosis from operative thermoelectric effects. It is therefore vital to recognize the special nature of the disease, choose the proper operation and pay at-tention to holistic therapy to avoid the reoccurrence.