45例宫颈原位腺癌临床分析

Clinical analysis of 45 cases of cervical adenocarcinoma in situ

目的探讨宫颈原位腺癌(adenocarcinoma in situ,AIS)的临床特征、诊断及治疗方式的选择。方法回顾性分析2014年1月至2020年12月在本院确诊的45例AIS患者的临床资料,分析其临床特征、宫颈癌筛查结果、治疗方式及预后,比较不同诊断及治疗方式的准确性及优势。结果45例患者中,宫颈AIS的发病年龄为(41.5±8.8)岁;阴道流血(31.1%,14/45)是发病最主要的临床症状;人乳头瘤病毒(HPV)16型(31.3%,14/45)和18型(51.1%,23/45)是最常见的感染类型;宫颈锥切术(90.0%,36/40)在明确AIS中效果最显著;阴道镜下活检首次发现AIS占60.0%(18/30);宫颈细胞学(6.7%,2/30)相较于HPV检测(97.6%,40/41)、阴道镜下活检(60.0%,18/30)相较于宫颈锥切术(90.0%,36/40)在发现AIS中差异有统计学意义(P<0.01)。宫颈细胞学、阴道镜下活检、宫颈锥切术在首次发现AIS上差异有统计学意义(P<0.001)。结论阴道流血是宫颈AIS最主要的临床特征;HPV16/18型感染是其主要原因;宫颈细胞学联合HPV检测可提高AIS的诊断率;阴道镜下活检在检出AIS中具有重要作用。

Objective To investigate the pathogenesis,clinical features,diagnosis and treatment of cervical adenocarcinoma in situ(AIS).Methods The clinical data of 45 patients diagnosed with AIS from Jan,2014 to Dec,2020 were retrospectively analyzed.The clinical characteristics,cervical cancer screening results,treatment methods and prognosis were analyzed and the accuracy and advantages of different diagnosis and treatment methods were compared.Results Among the 45 patients,the age of AIS was(41.5±8.8)years.Vaginal bleeding(31.3%,14/45)was the most common clinical symptom.Human papilloma virus(HPV)types 16(31.3%,14/45)and 18(51.1%,23/45)were the most common types of infection in AIS lesions.Cervical conization(90.0%,36/40)was most effective method in identifying AIS lesions.Colposcopic biopsy(60.0%,18/30)was higher in the first detection of AIS.Comparing with cytology(6.7%,2/30)and colposcopy(60.0%,18/30),HPV test(97.6%,40/41)and cervical conization(90.0%,36/40)had higher AIS detection rate,the difference was statistically significant(P<0.05).Cytology,colposcopy and cervical conization showed statistically significant differences in the first detection of AIS(P<0.001).Conclusions Vaginal bleeding is the primary clinical feature of AIS.HPV 16/18 infection is the main cause.The combined cytology and HPV test can improve the diagnosis rate of AIS.Colposcopic biopsy plays an important role in the detection of AIS lesions.