宫颈上皮内瘤样病变Ⅲ级76例临床分析

Clinical Analysis of Seventy-six Patients with Cervical Intra-epithelial Neoplasia Grade Ⅲ

【目的】探讨宫颈上皮内瘤样病变 (CIN)Ⅲ级临床病理特征、早期诊断、治疗方案和预后。【方法】对 76例宫颈上皮内瘤样病变临床病理表现、诊断早期诊断主要靠妇科普查、宫颈抹片及阴道镜下多点活检、治疗方法和预后进行分析评价。【结果】本组 76例中 ,19例 (2 5 % )无任何症状 ,72例 (95 % )有慢性宫颈炎 ;阴道镜下多点活检与术后病理诊断完全吻合者 5 6例 (占 73.7% ) ;14例重度非典型增生采用Leep术、宫颈锥切或子宫全切 ;6 2例原位癌采用Leep术、宫颈锥切、子宫全切术或扩大性子宫全切、次广泛性子宫切除。但年轻尚未生育的妇女采用宫颈锥切或Leep术 ,同时保留卵巢或行卵巢移位术。【结论】阴道细胞学涂片和阴道镜下多点活检能提高原位癌的早期诊断率 ;宫颈上皮内瘤样病变Ⅲ级各种术式治疗效果均好 ,但次广泛性子宫切除术的出血量明显多余其他术式。

[Objectives]To investigate the clinico-pathological feature, early diagnosis, therapeutic project and prognosis of grade Ⅲ cervical intra-epithelial neoplasia (CIN Ⅲ).The clinico-pathological manifestation, early diagnosis based mainly on gynecological general survey, cervical smear and vaginoscopic biopsy at multiple sites, methods of therapy and prognosis in 76 patients with CIN Ⅲ were analyzed and evaluated retrospectively.Nineteen out of 76 patients (25%) displayed no any symptom and 72 patients (95%) had chronic cervix inflammation. Vaginoscopic biopsies at multiple sites in 56 patients(73.7%) were entirely in conformity with their postoperative pathological diagnosis. Leep operation, cervicectomy or complete hysterectomy were performed in 14 patients with severe grade of atypical hyperplasia , while Leep operation, cervicectomy, complete hysterectomy or radical hysterectomy / sub-radical hysterectomy were used in 62 patients with primary cancer of uterine cervix. Young patients without childbirth were subjected to cervical conization or Leep operation, their ovaries were reserved or transposition of ovary was taken.[Conclusion]Regular smears of vaginal cytology and vaginoscopic biopsy at multiple sites can increase the early diagnostic rate of primary cervical cancer ; various types of surgical treatment in CIN Ⅲ bring about good therapeutic efficacy, but the amount of bleeding in radical hysterectomy is obviously much greater than other operations.