宫颈腺上皮内瘤样病变的临床分析

目的　探讨宫颈腺上皮内瘤样病变 (cervicalglandularintraepithelialneoplasia ,CGIN)的临床特点和治疗。方法　回顾性分析 12例CGIN的临床表现、术前宫颈细胞学、宫颈活检和 或宫颈管刮术 (ECC)、治疗方法、术后病理等资料。结果　 12例CGIN均为低度病变 (L -CGIN)。 1992～ 1997年有 3例 (2 5 0 % ) ,1998～2 0 0 3年有 9例 (75 0 % )。 33 3% (4 12 )宫颈脱落细胞学显示腺上皮异常 ,5 0 0 % (6 12 )宫颈多点活检为腺非典型性 ,2 12ECC提示腺异常 ;综合细胞学、活检、ECC等方法 ,术前 6 6 7% (8 12 )可发现腺体异常。 4 1 7%(5 12 )为单纯CGIN ,5 8 3% (7 12 )合并CIN ;术前对于单纯CGIN腺体异常的检出并未较CGIN合并CIN容易(P >0 0 5 )。 6 6 7% (8 12 )行子宫切除术 ,33 3% (4 12 )仅行冷刀锥切术。平均随访 5 0 4个月 ,均无复发或癌变。结论　宫颈细胞学联合阴道镜下宫颈多点活检和 或ECC可提高CGIN的术前诊断率 ;CGIN常合并CIN ;宫颈冷刀锥切术是年轻妇女保留生育功能者的有效治疗方法。

Clinical analysis of cervical glandular intraepithelial neoplasia

Objective To investigate the clinical characteristics and therapeutics of cervical glandular intraepithelial neoplasia(CGIN).Methods A retrospective study was carried out to analyze 12 patients with CGIN admitted in hospital from 1992 to 2003.Data from preoperative Pap smears,cervical biopsies,and endocervical curettages(ECCs),treatments,postoperative pathological examination were reviewed.Results All 12 cases were L-CGIN,including 3(25.0%)from 1992 to 1997 and 9(75.0%)from 1998 to June in 2003.Fore(33.3%)glandular lesions were reported by Pap smears.Biopsy and/or ECC detected 6(50.0%)glandular lesions.By combining the methods mentioned above,a glandular abnormality was suggested in 8(66.7%)cases preoperatively.Seven(58.3%)cases were associated with CIN while pure CGINs were 5(41.7%),and Fisher exact test showed no significance between them when referred to preoperative detection.Hysterectomy was performed in 8(66.7%)while 4(33.3%)patients were treated with cold knife cone alone.No recurrence was found during the follow-up of 50.4 months.Conclusions Combining Pap smear with biopsy and/or ECC may increase the sensitivity of detecting glandular lesions of CGIN before surgery.CGIN is co mmonly associated with squamous CIN.It is safe to perform cold knife cone(CKC)for patients desiring to preserve fertility.