宫颈CIN3的诊断与治疗——附301例病例分析

目的对子宫颈鳞状上皮高度病变（CIN3）患者进行回顾性分析,评估液基细胞学检查、高危型人乳头瘤病毒（HPV）检测、阴道镜下活检和冷刀锥切（CKC）诊断癌前病变的价值。方法回顾性分析2000年1月至2008年10月301例CIN3患者在北京大学人民医院妇科住院行CKC的的临床资料。210例患者在北京大学人民医院门诊行液基细胞学检查,91例在外院行液基细胞学检查。301例患者均经阴道镜下活检、病理学检查确诊为CIN3;229例行高危型HPV-DNA（HC2）检测。结果 301例患者液基细胞学检查结果：高度病变（HSIL）113例（37.54%）,低度病变（LSIL）76例（25.25%）,不典型增生（ASCUS）92例（30.56%）,正常20例（6.64%）。229例患者高危型HPV-DNA检测结果：阳性213例（93.01%）,RLU/CO平均值为548.2pg/ml;阴性16例（6.69%）。301例CKC病理检查结果：188例（62.46%）仍有CIN3病灶存在;9例（2.99%）锥切组织切缘阳性,进一步予以治疗;20例为早期浸润癌（6.64%）,再行子宫颈癌规范手术。结论对TCT、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;宫颈CKC能避免漏诊早期宫颈浸润癌,也是治疗CIN3的有效方法。

Clinical analysis of 301 patients with CIN3

Objective To evaluate the value of Thinprep cytologic test (TCT),human papillomavirus (HPV) test,colposcopy and cold knife conization (CKC) in diagnosis of cervical epithelial neoplasia Ⅲ (CIN3).Methods Clinical data of 301 patients who underwent CKC because of CIN3 diagnosed by colposcopy multiphase biopsy from January 2000 to October 2008 were analyzed retrospectively. All patients received TCT and colposcopy multiphase biopsy before CKC; 229 cases received HPV-DNA by Hybrid Capture2(hc2).Results There were 113 cases (37.54%) of HSIL,76 cases (25.25%) of LSIL,92 cases of ASCUS(30.56%) and 20 cases (6.64%) of normal detected by TCT. Among the 229 cases detected by HPV test there were 213 cases of positive result (93.01%) and 16 cases of negative result (6.69%). After CKC,there were 188 cases confirmed of CIN3 (62.46%),20 patients had invasive carcinoma(6.64%) and 9 patients had positive margins (2.99%). Conclusion The combination of TCT,HPV test,colposcopy and CKC can improve the accuracy of the diagnosis of cervical lesions,and may decrease the missed diagnosis rate.