宫颈原位癌及镜下早期浸润癌的诊断准确性分析  

Accuracy in diagnosis of carcinoma in situ and stage Ia cervical carcinoma

作　　者：李科珍[1] 黄小园[1] 陈刚[1] 马丁[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院肿瘤生物医学中心,武汉430030

出　　处：《华中医学杂志》2009年第5期229-231,共3页Central China Medical Journal

基　　金：国家自然科学基金资助项目(No.30271358)

摘　　要：目的了解宫颈原位癌及镜下早期浸润癌的各种筛查及诊断方法,总结不同的诊断方法对病理及临床分期的影响,探讨提高宫颈原位癌及镜下早期浸润癌术前诊断准确率的方法。方法回顾性分析2000年1月至2007年12月在同济医院行子宫全切手术治疗的168例宫颈原位癌及79例镜下早期浸润癌患者临床表现、诊断方法及术后病理诊断。所有患者均接受了子宫全切术或子宫颈癌根治术,其中201例术前接受了宫颈细胞学检查,223例术前接受了阴道镜下宫颈活检,16例术前接受了宫颈锥切手术。结果宫颈细胞学的临床分期准确率分别为:镜下早期浸润癌36.5%,宫颈原位癌81.1%;宫颈活检与宫颈锥切的病理类型准确率均为100%,0期临床分期准确率分别为92.6%与100%,Ⅰa期临床分期准确率分别为90.7%与100%。结论宫颈原位癌及镜下早期浸润癌的早期发现及确切分期与其诊断方法密切相关,宫颈细胞学检查联合宫颈活检可有效筛查宫颈癌早期病变,宫颈锥切术可有助于提高其诊断准确率。Objective To investigate the clinical character, diagnosis and treatment of cervical carcinoma in situ （CIS） and stage Ia cervical carcinoma, and improve the accuracy in diagnosis of the CIS and stage Ia cervical carcinoma. Methods One hundred and sixty-eight cases of CIS and 79 cases of stage Ia cervical carcinoma which undergoing total hysterectomy in our hospital from 2000 to 2007 were analyzed retrospectively. Results The accuracy of TCT in diagnosis of the CIS and stage Ia cervical carcinoma was 81.1% and 36. 5% restrictively. The accuracy of colposcopical biopsy and diagnostic conization in pathological types was both 100%, but in clinical stage of CIS was 92.6% and 100% restrictively, of Ia cervical carcinoma was 90.7% and 100%. Conclusion The combination of TCT and colposcopical biopsy can screen early stage of cervical lesions. Cervical conization can increase the accuracy in specific detection rate of the CIS and stage Ia cervical carcinoma. Cold knife conization （CKC） is a good choice for patient with CIS and desire for childbearing.

关 键 词：宫颈原位癌 镜下早期浸润癌 诊断 阴道镜检查 宫颈锥切术 

分 类 号：R737.33[医药卫生—肿瘤] R735.2[医药卫生—临床医学]