不同术式治疗宫颈鳞状上皮病变临床病理研究

目的 宫颈癌筛查的普及极大地提高了宫颈癌前病变的检出率,而病理诊断对宫颈癌前病变的诊疗至关重要,癌前病变的精确病理分级对于宫颈癌前病变治疗效果的评价和治疗方法的选择具有重要意义.本研究旨在探讨宫颈鳞状上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅱ和Ⅲ级病变采用环形电切除术(loop electrosurgical excision procedure,LEEP)和宫颈冷刀锥切术(cold knife conization,CKC)前后,病理分级变化及其对CIN的诊断治疗作用.方法 选择2015-01-01-2015-12 31在靖江市中医院就诊的经阴道镜多点活检病理确诊的CINⅡ和CINⅢ患者149例,随机数字表法分为LEEP组75例和CKC组74例,观察手术前后病理检查的符合度和病理降级、升级率.结果 阴道镜多点活检与LEEP术后CIN病理符合率为56.00％(42/75),LEEP术后病理降级率为21.33％(16/75),病理升级率为22.67％(17/75).阴道多点活检与CKC后CIN病理符合率为66.22％(49/74),病理升级率为12.16％(9/74),病理降级率为21.62％(16/74).宫颈冷刀锥切术和LEEP术后病理与术前病理符合率、病理升级率、病理降级率比较差异均无统计学意义,P＞ 0.05;复发率差异无统计学意义,P＞0.05.结论 CINⅡ和CINⅢ级病变LEEP术和CKC术后病理结果无差异,具有相同的治愈率.建议根据临床及患者意愿选择治疗方法.

Clinicopathological analysis of diferent surgical procedures on cervical squamous intraepithelial lesions

OBJECTIVE The popularity of cervical cancer screening greatly increases the rate of the precancerous lesions,and then the pathological diagnosis is very important for the diagnosis and treatment of the precancerous lesions.It is of great significance that the accurate pathological grade of the precancerous lesions is involved with the evaluation of the treatment effect and the choice of modality of those.The objective of this study was to elucidate the changes of histological grading and signaficance of treatment on CIN Ⅱ and CIN lⅢ involving LEEP and CKC.METHODS Totally 149 cases with the multifocal biopsy confirmed CIN Ⅱ and CINlⅢ pathologically in our hospital from January 2015 to December 2015 were collected and studied.The patients were randomly divided into LEEP group with 75 cases and CKC groups with 74 cases.The coincidence rate of pathological diagnosis,upgrading rate and downgrading rate of patients were.RESULTS The coincidence rate of CINs was 56.00％(42/75) in LEEP groups,while the pathological upgrading rate and pathological downgrading rate were 21.33％ (16/75) and 22.67 ％ (17/75),respectively.The coincidence rate was 66.22％(49/74) in CKC group with the pathological upgrade rating 12.16％ (9/74) and pathological downgrading rate were 21.62％ (16/74).There was no significant difference in coincidence of diagnosis,pathological upgrading rate and pathological downgrading rate between LEEP group and CKC group (P＞0.05).CONCLUSIONS There is no difference in postoperative pathological grades of patients with CIN Ⅱ and CIN Ⅲ between LEEP group and CKC group,indicating two methods have the same cure rate.It is suggested that the choice of surgical therapy can be according to patient's intentions and clinical conditions.