宫颈锥切术及冷冻病理检查诊治宫颈上皮内瘤样病变和早期宫颈癌应用分析
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摘要
目的探讨宫颈锥切术在诊断和治疗宫颈上皮内瘤样病变(CIN)和早期宫颈癌方面的价值以及宫颈锥切术术中送冷冻病理检查的必要性。方法回顾性研究2017年8月至2018年10月于郑州大学第一附属医院妇科收治的143例宫颈上皮内瘤样病变及可疑微浸润患者的临床资料,采用自身对照的方法,分析宫颈锥切术和阴道镜多点活检的病理结果差异,并比较术中送冷冻病理检查与术后常规病理的符合率。结果宫颈锥切术术后常规病理与阴道镜下多点活检病理符合者88例,不符合者55例,宫颈锥切术后病理诊断升级者15例(10.49%),浸润癌的漏诊率达2.80%。宫颈锥切术术中冷冻病理与术后常规病理的结果总体的符合率为42.16%,两者差异有统计学意义(P<0.05)。结论阴道镜多点活检在诊断宫颈上皮内瘤样病变及早期宫颈癌时存在明显的局限性,而宫颈锥切术不仅可以提高CIN及早期宫颈癌诊断的准确率,同时也是非常有效的治疗手段,但宫颈锥切术中的快速冷冻病理存在一定的局限性。
Objective To explore the value of cervical conization in the diagnosis and treatment of cervical intraepithelial neoplasia(CIN) and early cervical cancer, and the necessity of cryoprotective examination during cervical conization.Methods The clinical data of 143 patients with cervical intraepithelial neoplasia and suspicious microinvasions admitted to Gynecology Department of the First Affiliated Hospital of Zhengzhou University from August 2017 to October 2018 were retrospectively studied. The difference of pathological results between conization and colposcopy multipoint biopsy was analyzed by self-control method, and the frozen pathological examination during operation was compared. The coincidence rate with the routine pathology after operation.Results The routine pathology after cervical conization accorded with that of colposcopy biopsy in 88 cases, 55 cases did not accord with it, 15 cases(10.49%) had aggravated pathological diagnosis after cervical conization, and the missed diagnosis rate of invasive cancer was 2.80%. The overall coincidence rate of frozen pathology and routine pathology after cervical conization was 42.16%. The difference was statistically significant(P<0.05).Conclusion Colposcopy multipoint biopsy has obvious limitations in the diagnosis of CIN and early cervical cancer. Cervical conization can not only improve the diagnostic accuracy of CIN and early cervical cancer, but also is a very effective treatment, but the rapid freezing pathology in cervial conization has some limitations.
Objective To explore the value of cervical conization in the diagnosis and treatment of cervical intraepithelial neoplasia(CIN) and early cervical cancer, and the necessity of cryoprotective examination during cervical conization.Methods The clinical data of 143 patients with cervical intraepithelial neoplasia and suspicious microinvasions admitted to Gynecology Department of the First Affiliated Hospital of Zhengzhou University from August 2017 to October 2018 were retrospectively studied. The difference of pathological results between conization and colposcopy multipoint biopsy was analyzed by self-control method, and the frozen pathological examination during operation was compared. The coincidence rate with the routine pathology after operation.Results The routine pathology after cervical conization accorded with that of colposcopy biopsy in 88 cases, 55 cases did not accord with it, 15 cases(10.49%) had aggravated pathological diagnosis after cervical conization, and the missed diagnosis rate of invasive cancer was 2.80%. The overall coincidence rate of frozen pathology and routine pathology after cervical conization was 42.16%. The difference was statistically significant(P<0.05).Conclusion Colposcopy multipoint biopsy has obvious limitations in the diagnosis of CIN and early cervical cancer. Cervical conization can not only improve the diagnostic accuracy of CIN and early cervical cancer, but also is a very effective treatment, but the rapid freezing pathology in cervial conization has some limitations.
引文
[1] 陈志辽,林仲秋.HPV感染相关问题的再认识[J].中国癌症防治杂志,2018,10(4):262-266.
[2] 谭先杰,吴鸣,郎景和,等.子宫颈锥形切除术相关问题探讨(附390例临床分析)[J].中国肿瘤临床,2009,36(18):1071-1075.
[3] 范雪梅,张秋实,黄子健,等.阴道镜活检105例临床分析[J].实用医学杂志,2011,27(11):2002.
[4] 沈铿,郎景和,黄惠芳,等.子宫颈冷刀锥切术在宫颈上皮内瘤样病变诊断和治疗中的价值[J].中华妇产科杂志,2001,36(5):264-266.
[5] 杨惠娟,张玉勤,唐美琴,等.应用普通电刀的宫颈锥切术诊治宫颈上皮内瘤样病变和微小浸润癌的临床观察[J].中国癌症杂志,2006,16(11):922-925.
[6] 雷钧,李隆玉,程晓晓,等.宫颈原位腺癌诊断与处理方式的研究[J].江西医药,2013,48(6):476-478.
[7] TILLMANS T D,FALKNER C A,ENSLE D B,et al.Preoperative predictors of positive margins after loop electrosurgical excisional procedure-cone[J].Gynecol Oncel,2006,100(2):379-383.
[8] REN F,FENG W,SHI H R,et al.Value of frozen section examination in diagnosis and treatment of high-grade cervical intraepithelial neoplasia[J].Chin Med J(EngⅠ),2012,125(14):2462-2465.
[9] 王玉豪,王丰,严淑萍,等.宫颈锥切术术中快速冷冻检查诊断宫颈炎性病变及鳞状上皮内病变的准确性与局限性分析[J].河南医学研究,2017,26(4):608-610.
[2] 谭先杰,吴鸣,郎景和,等.子宫颈锥形切除术相关问题探讨(附390例临床分析)[J].中国肿瘤临床,2009,36(18):1071-1075.
[3] 范雪梅,张秋实,黄子健,等.阴道镜活检105例临床分析[J].实用医学杂志,2011,27(11):2002.
[4] 沈铿,郎景和,黄惠芳,等.子宫颈冷刀锥切术在宫颈上皮内瘤样病变诊断和治疗中的价值[J].中华妇产科杂志,2001,36(5):264-266.
[5] 杨惠娟,张玉勤,唐美琴,等.应用普通电刀的宫颈锥切术诊治宫颈上皮内瘤样病变和微小浸润癌的临床观察[J].中国癌症杂志,2006,16(11):922-925.
[6] 雷钧,李隆玉,程晓晓,等.宫颈原位腺癌诊断与处理方式的研究[J].江西医药,2013,48(6):476-478.
[7] TILLMANS T D,FALKNER C A,ENSLE D B,et al.Preoperative predictors of positive margins after loop electrosurgical excisional procedure-cone[J].Gynecol Oncel,2006,100(2):379-383.
[8] REN F,FENG W,SHI H R,et al.Value of frozen section examination in diagnosis and treatment of high-grade cervical intraepithelial neoplasia[J].Chin Med J(EngⅠ),2012,125(14):2462-2465.
[9] 王玉豪,王丰,严淑萍,等.宫颈锥切术术中快速冷冻检查诊断宫颈炎性病变及鳞状上皮内病变的准确性与局限性分析[J].河南医学研究,2017,26(4):608-610.