子宫颈锥切术在子宫颈上皮内瘤变诊断和治疗中的价值

目的 明确宫颈锥切术能否被阴道镜下多点活组织检查（活检）代替以及探讨宫颈锥切术在宫颈上皮内瘤变（CIN）诊断与治疗中的价值。方法 回顾性分析近5年来,因宫颈病变同时行宫颈细胞学检查、阴道镜下多点活检和宫颈锥切术的患者54例,采用自身对照法,对比研究宫颈锥切术和阴道镜下多点活检的病理检查结果。结果 宫颈锥切术与阴道镜下多点活检的病理检查结果完全符合者22例（40.7%),不符合者32例（59.3%)。在因除外浸润癌而行宫颈锥切术的31例中,与阴道镜下多点活检的病理检查结果一致者仅13例（41.9%)。宫颈锥切术后,因发现早期浸润部,行广泛子宫切除术者2例（3.7%);因CINⅢ级（CINⅢ）或微小逮润癌行全子宫切除术者13例（24.1%)。39例（73.2%)患者宫颈锥切术后密切随诊,保留了生育功能,在平均为18.3个月的随诊期内,无一例出现宫颈细胞学检查异常,其中3例妊娠并已分娩,宫颈锥切术主要的并发症是术后出血。结论 宫颈锥切术在CIN治疗中具有举足轻重的重要价值。它不能被阴道镜下多点活检所取代,对于患者CINⅢ又要保留生育功能的年轻患者,宫颈锥切术是较为适当的治疗方法。     

宫颈冷刀锥切治疗宫颈上皮内瘤样病变Ⅲ级的评价

目的 探讨阴道镜下多点活检与宫颈冷刀锥切对于宫颈上皮内瘤样病变Ⅲ级（CINⅢ）病理诊断的符合情况。方法 1995—2005年间对北京大学人民医院92例阴道镜下多点活检病理诊断为CINⅢ的患者进行宫颈冷刀锥切治疗，比较阴道镜下多点活检与宫颈冷刀锥切的病理结果之间的差异。结果 92例中有52例多点活检与冷刀锥切的病理结果一致，符合率为56．5％，40例多点活检与冷刀锥切的结果不同，其中11例多点活检诊断为CINⅡ／Ⅲ，而冷刀锥切诊断为微小浸润癌。结论 宫颈锥切是宫颈上皮内瘤样病变的一种重要诊断与治疗方法。阴道镜下多点活检病理提示宫颈上皮内瘤样病变Ⅲ级并伴随腺体受累可能是存在宫颈浸润癌的一个高危因素。人乳头瘤病毒（HPV）感染与宫颈病变有关，但未发现HPV高危型检测数值高低与患者病理级别之间的联系。     

阴道镜对宫颈上皮内瘤样病变的诊断价值分析

宫颈上皮内瘤样病变(cervical immepithelial neoplasia，CIN)是宫颈浸润癌演变发展过程中的癌前期病变阶段。对此阶段早期诊断和治疗是防治宫颈癌的关键环节。本研究采用阴道镜检查直接观察宫颈表面病变做出诊断，同时镜下定位活检，病理检查为最后诊断，同时以此做标准，以评价阴道镜检查对CIN的诊断价值。     

宫颈上皮内瘤样病变的诊断与治疗

目的:研究宫颈锥切术对宫颈上皮内瘤样病变的诊断及治疗价值。方法:对2009年11月至2010年10月在我院行阴道镜下多点活检及宫颈锥切术等的44例患者进行回顾性分析,并运用自身对照法,对阴道镜下多点活检和宫颈锥切术的检查效果等进行统计学分析。结果:阴道镜下多点活检与宫颈锥切术病理检查不符合者27例(61.4%),完全符合者17例(38.6%);在因早期浸润而行宫颈锥切术27例中,阴道镜下多点活检其病理检查结果完全符合的仅11例(39.3%),在宫颈锥切术后,对发现的早期浸润癌行广泛子宫切除术2例(4.5%);因CNⅡ级或Ⅲ及有微小浸润而行全子宫切术9例(20.5%);对行宫颈锥切术的33例患者进行术后随访,所有患者均保留了生育功能,且在18个月的随访中,未发现有患者宫颈细胞学检查结果异常。结论:宫颈锥切术在宫颈上皮内瘤样病变的诊断及治疗中具有重要的价值,阴道镜下的多点活检术不能将其取代。是临床值得推荐的诊断及治疗方法,尤其对于具CINⅢ级且想保留生育功能患者。     

阴道镜检查对宫颈上皮内瘤样病变的诊断价值探讨

目的 探讨阴道镜对宫颈上皮内瘤样病变（CIN)的诊断价值。方法 分析我院近年宫颈疾患701例阴道镜的检查结果。结果 CIN检出率阴道镜组显著高于肉眼检查组，且以30～49岁段为主，占68．5％。阴道镜图像中以血管异常为主占59％。阴道镜下活检与术后病理诊断的符合率为75％。结论 阴道镜是辅助诊断CIN的重要环节，可以提高CIN检出率。     

宫颈上皮内瘤变锥切术后复发因素的研究进展

宫颈上皮内瘤变是浸润性宫颈癌的癌前病变,由于发病年龄年轻化,治疗多采用保留生育功能的宫颈锥切术,但术后有较高复发率,其原因可能有生物学因素,如HPV病毒和HIV病毒感染、锥切术标本切缘阳性和切缘细胞核变化、宫颈腺体受累、巨噬细胞浸润、行为因素如吸烟及患者年龄等。     

宫颈上皮内瘤样病变的手术治疗

1 背景 目前宫颈上皮内瘤样病变（CTV）的治疗主要是根据疾病的性质和范围行局部切除或切除。阴道镜检查出现以前，传统上所有病灶在全麻下都用刀行锥切活检或电凝法行点根治术，而现在更趋向于各种可用于门诊病人的更保守的局部切除和切除治疗。     

宫颈冷刀锥切术诊治宫颈上皮内瘤变Ⅲ级320例临床分析

目的:探讨宫颈锥切术在宫颈上皮内瘤变Ⅲ级(CINⅢ)的诊断与治疗中的价值。方法:回顾性分析因宫颈CINⅢ行宫颈锥切术的患者320例,采用自身对照法,对比研究宫颈锥切术和阴道镜下活检的病理结果。结果:宫颈锥切术与阴道镜下检查的病理结果完全符合者187例(58.44%),不符合者133例(41.56%)。锥切术后病理诊断级别下降者69例(21.56%),漏诊微小浸润癌60例(Ⅰa1期55例,Ⅰa2期5例)(18.75%),漏诊浸润癌(Ⅰb1期)4例(1.25%)。59例患者再次行子宫切除术,其中32例(54.24%)术后病理转阴,16例病理诊断级别降低。宫颈锥切术的主要并发症是术后出血。结论:宫颈锥切术在CINⅢ的诊断和治疗中具有重要价值。应根据患者年龄、病变程度、切缘状态、生育要求等多方面个体化、综合考虑以决定进一步的治疗方案。     

阴道镜对宫颈上皮内瘤变的诊断价值

目的：评价阴道镜检查对宫颈上皮内瘤样病变（CIN）的诊断价值。方法：对1991年5月至2002年4月进行阴道镜检查的患者1407例，行镜下定位取活组织病理检查。结果：近4年来CIN的发病例数呈上升趋势，发病年龄在30－39岁的病例占80．29％，经病理确诊CIN406例，包括CIN Ⅰ209例，CINⅡ104例和CINⅢ（包括CIS）93例；慢性宫颈炎625例，湿疣187例，息肉139例，其他50例（包括宫颈纳氏囊肿28例，子宫内膜异位症13例，乳头状瘤9例），阴道镜检查对CIN的诊断准确性为79．67％，敏感性为96．06％，特异性为73．03％，阳性预测值为59．095，阴性预测值为97．86％。CIN在阴道镜下的图像以醋酸白色上皮的出现率最高为83．50％，对CIN诊断的敏感性和阴性预测值高；与点状区和（或）镶嵌同时存在时，对CIN诊断的敏感性下降，特异性升高，结论：阴道镜检查对CIN的诊断价值在于其敏感性和阴性预测值高，在国内适合作为CIN的筛查方法，统一阴道镜的评分标准意义重大。     

宫颈冷刀锥切术和宫腔镜下宫颈锥切术治疗高级别宫颈上皮内瘤变的疗效分析

目的:比较宫颈冷刀锥切术(CKC)和宫腔镜下宫颈锥切术(TCRC)对于宫颈上皮内瘤变(CIN)Ⅱ、Ⅲ的临床疗效。方法:选取2010年1月1日至2014年6月1日就诊于南方医科大学珠江医院,手术、病理及随访资料完整的CINⅡ、Ⅲ患者共176例,其中CKC组62例,TCRC组114例。比较两组患者年龄、孕产次数及术前病理分级并评估手术时间、术中出血量、术后阴道流血及病理切缘阳性和术后宫颈狭窄、复发等情况。结果:两组患者年龄、孕产次数及术前CIN分级差异均无统计学意义(P0.05)。CKC组术中平均出血量(14.16±14.10 ml)、平均住院时间(5.73±1.43天)与TCRC组(29.80±20.55 ml,4.75±1.23天)比较差异有统计学意义(P0.05)。CKC组平均手术时间(33.15±11.42分钟)、术后阴道流血率(33.9%)、病理切缘阳性率(3.2%)、宫颈狭窄率(4.8%)、复发率(4.8%)与TCRC组(分别为33.18±14.61分钟、21.1%、5.3%、4.4%、3.5%)比较差异无统计学意义(P0.05)。CKC组术前宫颈活检病理和术后病理结果一致率为74.2%(46/62),TCRC组为72.8%(83/114),kappa值0.75。结论:两种方法用于治疗高级别宫颈上皮内瘤变均安全有效。与CKC相比,TCRC可减少患者住院时间,但可能增加术中出血量,需在手术中注意。     

Prediction of disease persistence after conization for microinvasive cervical carcinoma and cervical intraepithelial neoplasia grade 3

We attempted to determine the significant variables and to predict the probability of disease persistence after conization for microinvasive cervical carcinoma and cervical intraepithelial neoplasia grade 3 (CIN3). We analyzed 133 patients from 2001 to 2002 who had a subsequent hysterectomy after conization. The histological findings of the cone specimens, together with the clinical parameters, were correlated with the presence of residual dysplasia in the hysterectomy specimen. The probability of having residual dysplasia was calculated based on the function of the significant variables obtained by logistic regression analysis. Of the 133 patients, 42 (31.6%) had residual disease in their hysterectomy specimens. Using multivariate analysis only for the postmenopausal state, positive endocervical curettage, positive margin, and microinvasive carcinoma were predictive of residual dysplasia. The probabilities of having residual dysplasia were about 0.99, 0.84, 0.4, 0.07, and 0.01 in patients with a presence of all four, any three, any two, any one, and no risk factors, respectively. The best cutoff probability determined by the receiver operating characteristic curve was 0.32, yielding a sensitivity of 81% and a specificity of 88%. Based on these results, patients with the presence of any two or more of the risk factors mentioned above should be considered as a high-risk group for having disease persistence after conization for the treatment of CIN3 and microinvasive carcinoma.     

子宫颈冷刀锥切术诊治子宫颈上皮内瘤变61例临床分析

目的探讨宫颈冷刀锥切术（CKC）在宫颈上皮内瘤变（CIN）诊治中的价值。方法对2010年1月至2011年10月在北京大学人民医院妇科门诊经阴道镜下活检病理确诊为CIN2／3并行CKC的61例患者的临床资料进行回顾性分析。结果CKC术后与术前阴道镜活检病理级别的符合率为78．7％（48／61）,其中16．4％（10／61）升级,4．9％（3／61）降级。发现宫颈浸润癌8例,切缘阳性2例。结论CKC是一种诊断治疗宫颈上皮内瘤变的简单、安全的方法,可以提高CIN2／3诊断准确率,有助于宫颈浸润癌的早期诊断。     

宫颈上皮内瘤变锥切术后残留或复发相关因素Meta分析

目的 探讨宫颈上皮内瘤变锥切术后残留或复发相关因素。 方法　以宫颈上皮内瘤变、锥切、残留、复发因素的中英文为检索词,检索2006年1月至2013年6月Pubmed、中国知网、万方数据库收录的文献,研究设计类型为病例对照研究或队列研究,提取信息,应用RevMan 5.0软件进行Meta分析。结果　检索到符合纳入标准的文章15篇,随访总例数2721例。Meta分析结果显示：锥切术后残留或复发危险因素为：年龄超过50岁（OR =3.67,95%CI 2.44 ～5.52）、切缘阳性（OR=4.43,95%CI 3.42 ～5.75）、腺体累及（OR=4.54,95%CI 2.22 ～9.30）、术前人乳头瘤病毒高负荷（OR=6.51,95%CI 4.32 ～9.81）、术后高危人乳头瘤病毒持续阳性（OR=33.39,95%CI 16.86 ～66.14）、人类免疫缺陷病毒（HIV）感染（OR=5.60,95%CI 3.10 ～10.11）、绝经（OR=2.32,95%CI 1.35 ～3.99）;而吸烟（OR＝1.37,95%CI 0.75 ～2.51）是锥切术后残留或复发的相关因素尚无统计学意义。结论　年龄≥50岁、切缘阳性、腺体累及、术前高危人乳头瘤病毒高负荷、术后高危人乳头瘤病毒持续阳性、HIV感染和绝经是锥切术后病灶残留或复发的危险因素,而吸烟不是锥切术后病灶残留或复发的危险因素。     

Pregnancy outcome in patients treated with cervical conization for cervical intraepithelial neoplasia

Objective

To examine the causal contribution of conization to premature delivery.

Methods

This was a retrospective, case-control, multicenter study of women who underwent conization in 5 hospitals in the Basque Country (Spain) from 1998 to 2007. Three study groups were established: group A, post-conization infant deliveries; control group B, pre-conization infant deliveries; and control group C, infant deliveries without conization.

Results

Comparing group A with group C, there was a higher rate of preterm delivery before 35 weeks (5.3% versus 1.6%), a lower mean birth weight (3156.2 g versus 3328.5 g), and a greater prevalence of infants under 2500 g (10.6% versus 3.7%). There were no significant differences between group A and group B: preterm delivery before 35 weeks (5.3% versus 4.8%), mean birth weight (3156.2 g versus 3119.4 g), and prevalence of infants under 2500 g (10.6% versus 10.6%).

Conclusion

Pregnancy in women post-conization was associated with a risk of preterm delivery. However, there were no significant differences between women who underwent conization before and those who underwent conization after delivery. Cervical conization does not necessarily increase the risk of preterm delivery in subsequent pregnancy. Conization should be considered an indicator of such risk because it is associated with pregnancy complications arising from socio-epidemiologic factors present in women requiring conization that are also present in women who have premature delivery.     

Risk factors for human papillomavirus persistence among women undergoing cold-knife conization for treatment of high-grade cervical intraepithelial neoplasia

Objective

To investigate the risk factors potentially associated with high-risk human papillomavirus (HPV) persistence in women undergoing cold-knife conization (CKC) for treatment of high-grade cervical intraepithelial neoplasia (CIN).

Methods

Medical records of women who underwent CKC for treatment of CIN 2/3 between 2007 and 2012 at a tertiary hospital in Ankara, Turkey, were retrospectively analyzed. Cases involving persistent HPV infection after 1 year of follow-up were identified. Using univariate and multivariate analyses, the impact of various factors such as patient age, menopausal status, parity, high-risk HPV type, excised cone dimensions (width, height, and depth), and surgical margin status on high-risk HPV persistence was assessed.

Results

A total of 292 women underwent CKC for treatment of CIN 2/3 within the study period. After women with a subsequent diagnosis of cervical cancer, subsequent total hysterectomy, and inadequate follow-up data were eliminated, 113 women were eligible for final analysis. High-risk HPV persistence was detected in 24 (21.2%) women, and multivariate analysis revealed that patient age and cone depth were significant independent predictors (P < 0.05).

Conclusion

High-risk HPV persistence may be encountered after CKC procedures. It is important to evaluate persistent HPV infections after treatment because affected women are at increased risk for disease persistence, recurrence, and progression.     

宫颈上皮内瘤变早期诊断的临床研究

目的 进一步评价细胞学、阴道镜在宫颈上皮内瘤变(CIN)早期诊断中的应用价值。方法 回顾性分析114例CIN的宫颈涂片、阴道镜检查的结果，与活检组织病理学的结果进行对比研究。结果 114例CIN中CIN Ⅰ 44例、CIN Ⅱ 30例、CIN Ⅲ 40例，87例有白带增多、外阴痒、性交后出血等症状。细胞学检出了绝大部分病变98．2％，阴道镜检出病变97．4％。结论 细胞学、阴道镜检查等手段各有利弊，联合应用能够显著提高诊断水平。