宫颈CIN3 160例的临床分析与随访  

Clinical analysis and follow-up of 160 patients with CIN3

作　　者：邹冰玉[1] 张潇潇[1] 林丽[2] 

机构地区：[1]四川省人民医院妇产科,四川成都610072 [2]成都军区空军司令部门诊部,四川成都610041

出　　处：《四川医学》2012年第4期620-622,共3页Sichuan Medical Journal

摘　　要：目的评估液基细胞学检查、高危型人乳头瘤病毒(HPV)检测对诊断、随访重度宫颈上皮内瘤变的价值,探讨CIN3的最佳治疗方式。方法回顾性分析2000年1月～2009年12月160例CIN3患者在四川省人民医院妇科住院治疗的临床资料。160例患者均在我院或外院门诊行液基细胞学检查,并在我院门诊经阴道镜下活检诊断为CIN3。75例行高危型HPV-DNA(HC2)检测。70例患者直接行全子宫切除术,90例患者行冷刀锥切术(CKC)。结果 160例患者液基细胞学检查结果:高度上皮内病变(HSIL)44例(27.50%),低度上皮内病变(LSIL)40例(25.00%),不典型增生(ASCUS)61例(38.13%),正常15例(9.38%)。75例患者高危型HPV-DNA检测结果:阳性71例(94.67%),阴性4例(5.33%)。术后病理升级者(早期浸润癌)8例(5.00%),3例全子宫切除患者术后补充放化疗,5例锥切患者术后行子宫颈癌规范手术;降级者29例(18.13%),其中炎症7例(4.39%)。对于仅行冷刀锥切术且切缘阴性的56例患者进行了1～3年的随访,至今无1例复发。结论对LCT异常或HPV检测阳性者行阴道镜检查及宫颈活检可提高宫颈病变的检出率,LCT、HPV检测也是术后追踪随访的主要手段;宫颈CKC能避免过度治疗和漏诊早期宫颈浸润癌。Objective To evaluate the value of liquid-based cytology test（LCT） and human papillomavirus（HPV） test in diagnosis and follow-up of cervical epithelial neoplasia m（CIN3）,and to discuss the best treatment of CIN3.Methods Clinical data of 160 patients who underwent CKC or hysterectomy because of CIN3 diagnosed by colposcopy multiphase biopsy from January 2000 to December 2009 were analyzed retrospectively.All patients received LCT and colposcopy multiphase biopsy;75 cases received HPV-DNA by Hybrid Capture2（hc2）.Seventy patients underwent hysterectomy directly and 90 patients received cold knife conization（CKC） at first.Results There were 44 cases（27.50%） of HSIL,40 cases（25.00%）of LSII,61 cases of ASCUS（38.13%） and 15 cases（9.38%） of normal detected by LCT.And there were 71 cases of positive result（94.67%）and 4 cases of negative result（5.33%） in HPV test.After CKC and hysterectomy,there were 8 cases of invasive carcinoma（5.00%） and 7 cases of inflammation.Three patients of invasive carcinoma who had underwent hysterectomy received chemotherapy and radiotherapy and 5 patients of invasive carcinoma who underwent CKC received radical hysterectomy subsequently.After CKC,56 cases with negative margin were followed up for 1~3years.No one had been found reoccurred disease.Conclusion The accuracy of the diagnosis of cervical lesions could be improved by LCT combined HC2,as well as the effective follow-up methods after CKC.CKC can avoid overtreatment of cervical lesions,and may decrease the missed diagnosis rate.

关 键 词：液基细胞学 HPV检测 阴道镜 宫颈上皮内瘤 冷刀锥切术 

分 类 号：R737.33[医药卫生—肿瘤]