宫颈原位腺癌29例临床分析  

Clinical analysis of 29 cases of adenocarcinoma in situ of the cervical

作　　者：白杨[1] 史中娜[1] 刘琰[1] 张峰[1] BAI Yang;SHI Zhongna;LIU Yan;ZHANG Feng(Department of Gynecology,The Third Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第三附属医院妇科,河南郑州450052

出　　处：《安徽医药》2023年第2期378-382,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨宫颈原位腺癌(AIS)的临床特点和诊疗方式。方法回顾性分析2017年10月至2020年11月就诊于郑州大学第三附属医院的29例宫颈原位腺癌病人的临床表现、诊断方法、手术方式及最终诊断。结果病人年龄(41.66±9.04)岁,27.6%表现为阴道不规则出血,72.4%无自觉症状。细胞学提示腺上皮异常比例为7.4%,人乳头瘤病毒(HPV)16/18型阳性比例88.9%。74.1%阴道镜印象为鳞状上皮异常,阴道镜下多点活检的AIS检出率为63.0%(17/27)。宫颈锥切术的AIS及以上病变检出率为79.3%(23/29)。69.0%的病人存在腺上皮病变同时合并鳞状上皮病变。13.8%(4/29)的AIS病人存在浸润腺癌。22例切除子宫的病人术后子宫标本的病灶残留率为63.6%。宫颈锥切术切缘阳性病人的病灶残留率(100%,7/7)显著高于切缘阴性者(46.7%,7/15),差异有统计学意义。结论AIS的细胞学敏感性低,阴道镜表现不典型,且常合并鳞状上皮病变,AIS的处理方案应结合宫颈锥切术后病理及切缘状态共同决定,切缘阴性的病人仍需密切随访。Objective To investigate the clinical characteristics and treatment methods of adenocarcinoma in situ(AIS)of the cervical cervix.Methods The clinical manifestations,diagnostic methods,surgical procedures and final diagnosis of 29 patients with AIS of the cervical cervix who attended the Third Affiliated Hospital of Zhengzhou University from October 2017 to November 2020 were retrospectively analyzed.Results The age of the patients was(41.66±9.04)years,27.6% presented with irregular vaginal bleeding and 72.4% had no conscious symptoms.The percentage of abnormal glandular epithelium suggested by cytology was 7.4%,and the percentage of positive human papillomavirus(HPV)16/18 was 88.9%.The colposcopic impression of 74.1%of patients was abnormal squamous epithelium,and the detection rate of AIS on colposcopic multipoint biopsy was 63.0%(17/27).The detection rate of AIS and above was 79.3%(23/29)for cervical conization.A total of 69.0%of patients had glandular epithelial lesions with combined squamous epithelial lesions.Invasive adenocarcinoma was present in 13.8%(4/29)of patients with AIS.The residual lesion rate in postoperative uterine specimens was 63.6% in the 22 patients who underwent hysterectomy.The residual lesion rate was significantly higher in patients with positive cervical conization margins(100%,7/7)than in those with negative margins(46.7%,7/15),with a statistically significant difference.Conclusions AIS has low cytologic sensitivity and atypical colposcopic presentation,and is often combined with squamous epithelial lesions.Management of AIS should be decided jointly with postcervical conization pathology and margin status,and patients with negative margins still require close follow-up.

关 键 词：宫颈肿瘤 原位腺癌 阴道镜 宫颈活检 宫颈锥切术 

分 类 号：R737.33[医药卫生—肿瘤]