高度宫颈上皮内瘤变99例临床分析

Diagnosis and treatment of clinical analysis of 99 cases of high-grade cervical intraepithelial neoplasia

关键词:  高度宫颈上皮内瘤变  阴道镜  宫颈锥切术  术中冰冻

Key words:  cervical intraepithelial neoplasia  colposcopy  conization  frozen sections

摘要:

［目的］探讨高度宫颈上皮内瘤变（high-grade cervical intraepithelial neoplasia，CIN）的临床特点及诊治方法。［方法］ 回顾性分析2002年1月—2007年7月在大连医科大学附属第一医院阴道镜下活检诊断为CIN III的99例患者的临床资料，对术前阴道镜下活检病理、术中快速冰冻病理和术后石蜡切片病理进行对照研究。［结果］术后石蜡切片病理与阴道镜下活检病理结果对照，升级6例，占6.06%。38例患者行术中快速冰冻病理，术后石蜡切片病理与术中快速冰冻病理比较，升级17例，占44.74%。［结论］阴道镜下多点活检具有一定的局限性，在此基础上行宫颈锥切术进一步明确诊断是必要的；术中冰冻有一定的临床应用价值，但不建议应用于宫颈上皮内瘤变的诊治中。

Abstract:

[Objective] To investigate the clinical characters and methods of diagnosis and treatment of high-grade cervical intraepithelial neoplasia (CIN III). [Methods] Retrospectively analyzed clinical data of 99 cases of CIN III diagnosed by colposcopic multiple biopsies at the First Affiliated Hospital of Dalian Medical University from January 2002 to July 2007. It was focused on the comparative study about the pathology of preoperative colposcopic multiple biopsies, postoperative tissue examination and frozen sections. [Results] Fifty cases accepted total hysterectomy and 49 cases accepted cervical conization. Compared with colposcopic multiple biopsies，the histological paraffin section after operations were not identical in 34 cases (34.34%)，6(6.06%) of them upgraded to early invasive cancer. Thirty-eight cases accepted frozen sections，compared with the pathology of postoperative tissue，there were not identical in 18 cases (47.37%), 17 cases (44.74%) upgraded. [Conclusion] Colposcopic multiple biopsies have some limitations，so cervical conization is needed sometimes. Intraoperative frozen section is worth to be used in clinic，but it is not suitable for the diagnosis of CIN.