高级别宫颈上皮内瘤变病理三维成像特征与证的相关性  

Correlation between pathological three-dimensional imaging features and syndromes of highgrade cervical intraepithelial neoplasia

作　　者：黄梅芳 刘用诚 龚婷婷[2] 林建龙[2] 吴冬梅[2] Huang Meifang;Liu Yongcheng;Gong Tingting;Lin Jianlong;Wu Dongmei(Fujian University of Traditional Chinese Medicine,Fuzhou Fujian 350122;The Second People′s Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou Fujian 350122)

机构地区：[1]福建中医药大学,福建福州350122 [2]福建中医药大学附属第二人民医院,福建福州350122

出　　处：《山西中医药大学学报》2025年第2期185-190,共6页Journal of Shanxi University of Chinese Medicine

基　　金：第五批全国中医临床优秀人才研修项目(国中医药人教函[2022]1号);福建省卫健委科技计划项目(2020CXA051)。

摘　　要：目的:探讨高级别宫颈上皮内瘤变(HSIL)病理三维成像特征与证的相关性。方法:采集首次行宫颈锥切术,且术后病理确诊为HSIL的63例患者的中医四诊信息、阴道镜影像表征进行中医辨证,应用病理三维重建技术(PTDR)对宫颈锥切病理切片进行三维重建,获取病理三维成像特征。结果:63名HSIL患者中,脾虚湿困证17例,湿毒蕴结证16例,阴虚夹湿热证13例,湿热下注证10例,肾阳虚证7例。63名HSIL患者中病灶≥1 cm 22例,病灶<1 cm 41例;病灶累及腺体42例;病灶单一象限分布17例,病灶分布2个象限23例,病灶分布3个象限18例,病灶分布4个象限5例;切缘阳性15例,切缘阴性48例;单一病灶分布33例,多个病灶分布30例。HSIL患者中医证型与宫颈锥切病理切片三维特征有相关性,16例湿毒蕴结证HSIL患者宫颈锥切标本病灶≥1 cm(10/16)、病灶分布象限>2个(13/16)、多病灶(12/16)的患者占比较高,13例阴虚夹湿热证HSIL患者宫颈锥切标本病灶<1 cm(12/13)、单病灶(11/13)的患者占比较高,17例脾虚湿困证HSIL患者病灶分布象限≤2个(15/17)的患者占比较高,差异均有统计学意义(P<0.05)。不同证型HSIL患者宫颈锥切标本病灶累及腺体及病灶切缘状态比较,差异均无统计学意义(P>0.05)。结论:随着湿热程度的加重,宫颈内上皮瘤变病灶呈现加重趋势,残留、复发风险因素增加。临床上,可以根据湿热程度,分层管控,及时进行中医药干预,促进湿热毒消退,以降低不良结局发生。Objective:To investigate the correlation between pathological three-dimensional imaging features and syndromes of high-grade cervical intraepithelial neoplasia(HSIL).Methods:A total of 63 patients who underwent cervical conization for the first time and were diagnosed as HSIL by postoperative pathology were selected.The information of four TCM diagnoses and colposcopy images were collected for TCM syndrome differentiation.The pathological sections of cervical cone were reconstructed by pathological three-dimensional reconstruction(PTDR),and the pathological threedimensional imaging features were obtained.Results:Among the 63 patients with HSIL,there were 17 cases of spleen vacuity with damp encumbrance syndrome,16 cases of accumulation of dampness and toxicity syndrome,13 cases of Yin deficiency combined with dampness-heat syndrome,10 cases of down-flowing of dampness and heat syndrome,and 7 cases of kidney-Yang deficiency syndrome.Among 63 HSIL patients,22 had lesions≥1 cm and 41 had lesions<1 cm.The lesions involved glands in 42 cases.There were 17 cases with lesions in one quadrant,23 cases with lesions in two quadrants,18 cases with lesions in three quadrants,and 5 cases with lesions in four quadrants.There were 15 cases of positive resection margin and 48 cases of negative resection margin.There were 33 cases with single lesion and 30 cases with multiple lesions.The TCM syndrome types of HSIL patients were correlated with the three-dimensional characteristics of cervical conization pathological sections.The proportion of lesions≥1 cm(10/16),lesion distribution quadrants>2(13/16)and multiple lesions(12/16)in cervical conization specimens of 16 patients with HSIL with accumulation of dampness and toxicity syndrome was relatively high.The proportions of lesions<1 cm(12/13)and single lesion(11/13)in cervical conization specimens of 13 HSIL patients with Yin deficiency combined with dampness-heat syndrome were relatively high.Among the 17 patients with HSIL of spleen vacuity with damp encumbrance,the proporti

关 键 词：高级别宫颈上皮内瘤变 中医辨证 相关性 病理三维成像特征 

分 类 号：R711.74[医药卫生—妇产科学] R271.9[医药卫生—临床医学]