子宫颈上皮内瘤变治疗过度与不足分析

Analysis of excessive and inadequate treatment for cervical intraepithelial neoplasia

目的分析子宫颈上皮内瘤变(CIN)治疗中的过度与不足。方法回顾性选取2017年5月至2019年5月上海交通大学医学院附属第九人民医院黄浦分院妇产科收治的CIN患者103例,依据随机数字表法分为两组:一组为宫颈环形电切术组(n=83),一组为全子宫切除术组(n=20),均接受病理学检查,分析阴道镜活检与宫颈环形电切术术后病理、阴道镜活检与全子宫切除术术后病理。结果宫颈环形电切术组患者中,术前活检CINⅠ37例,CINⅡ36例,CINⅢ10例;宫颈环形电切术术后病理CINⅢ12例,CINⅡ25例,CINⅠ15例,炎症31例。病理级别比较一致37例,上升13例,下降33例,术后病理结果的完全符合率为44.6%。全子宫切除术组患者中,术前活检CINⅡ3例,CINⅢ17例;全子宫切除术术后病理早侵3例,CINⅢ12例,CINⅡ2例,CINⅠ1例,炎症2例。病理级别比较一致12例,上升4例,下降4例,术后病理结果的完全符合率为60.0%。结论阴道镜活检难以检出宫颈管中、宫颈上皮深处的病灶,宫颈环形电切术能够在一定程度上弥补阴道镜活检的不足,从而有效诊治患者,临床应该综合处理干预CIN,依据患者的年龄、病变范围、医疗资源等对患者进行综合评估,以避免治疗过度或治疗不足。

Objective To analyze the gains and losses of excessive treatment for cervical intraepithelial neoplasia(CIN).Methods 103 cases of patients with cervical intraepithelial neoplasia from May 2017 to May 2019 in Department of Obstetrics,Shanghai Jiaotong University School of Medicine Affiliated to Ninth People’s Hospital Huangpu Hospital were retrospectly selected.They were divided into two groups:one group of cervical circumferential electrotomy(n=83)and the other group of total hysterectomy(n=20)according to the random table method.All patients underwent pathological examination.The pathological changes after colposcopic biopsy and cervical circumferential electrotomy,colposcopic biopsy and total hysterectomy were analyzed.Results Among the patients in the cervical circumferential electrotomy group,37 cases were CIN I,36 cases were CIN II,10 cases were CIN III,31 cases were pathological inflammation after cervical circumferential electrotomy,15 cases were CIN I,25 cases were CIN II and 12 cases were CIN III.Pathological grade was consistent in 37 cases,increased in 13 cases and decreased in 33 cases.The complete coincidence rate of pathological results was 44.6%.In the total hysterectomy group,preoperative biopsy showed CIN II in 3 cases and CIN III in 17 cases.Pathological inflammation after total hysterectomy included 2 cases,CIN I in 1 case,CIN II in 2 cases,CIN III in 12 cases and early invasion in 3 cases.The pathological grade was consistent in 12 cases,increased in 4 cases and decreased in 4 cases.The complete coincidence rate of pathological results was 60.0%.Conclusion Colposcopic biopsy is difficult to find out the deep lesions in the cervical canal and cervical epithelium.Cervical circumferential electrotomy can make up for the deficiencies of colposcopic biopsy to a certain extent,so as to effectively diagnose and treat patients.CIN intervention should be comprehensively dealt with in clinic,and patients should be comprehensively evaluated according to their age,range of lesions,medical resources and so on.It should not be overtreated or undertreated.