220例宫颈上皮内瘤变的临床分析

目的：探讨宫颈上皮内瘤变（CIN）的不同处理方法及预后。方法：选择宫颈癌筛查CIN患者220例,116例CINⅠ作为单纯随访组,104例包括CINⅠ53例、CINⅡ37例、CINⅢ14例作为治疗组。治疗组中物理治疗者共50例,宫颈锥切术治疗25例,高频电波刀宫颈电圈切除术（LEEP）20例,子宫全切术治疗共9例。所有病例随访2年。结果：单纯随访组第6,12和24个月CINⅠ自然转阴率分别为29.31%（34/116）、55.14%（59/107）、83.51%（81/97）,病变持续率分别为69.83%（81/116）、43.92%（47/107）、14.43%（14/97）;单纯随访组第24个月HPV高危型转阴率为27.45%（14/51）,HPV低危型转阴率为47.06%（24/51）,进展病例均为HPV高危型阳性。治疗组中CINⅠ和CINⅡ物理治疗者1年内复发率分别为4.88%（2/41）、22.2%（2/9）,CINⅡ及CINⅢ行宫颈锥切或LEEP患者均未见复发者。目前所有病例仍在继续随访。结论：多数CINⅠ病变会自然消退,HPV也自然清除,但对于HPV持续阳性的患者应警惕其进展为高度CIN。随访病例要选择阴道镜满意,病灶范围小,自愿接受随访者;CINⅡ级及CINⅢ级应选用宫颈锥切或LEEP治疗,但CINⅢ级需长期随访。对于宫颈高度病变则不推荐使用物理治疗。

Clinical Analysis on 220 Cases of Treatment of Cervical Intraepithelial Neoplasia

Objective： To discuss the different treatment and prognosis of cervical intra-epithelial neoplasia. Methods： 220 cases of CIN selected by cervical cancer screening were chosen, which were divided into simple follow-up group and treatment group. The simple follow-up group has 116 cases of CIN I and the treatment group has 53 cases of CIN1, 37cases of CINⅡ, 14 cases of CINⅢ. Physical therapy in 50 patients, cervical conization method in 25 cases, LEEP in 20 cases, hysterectomy in 9 cases. All patients were followed for 2 years. Results： At 6, 12, 24 month, simple follow-up group on the natural negative CINI were respectively 29.31%（34/116）, 55.14%（59/107）, 83.51%（81/97）; sustained rate of disease were respectively 69.83%（81/116）, 43.92%（47/107）, 14.43%（14/97）; the first 24 months of simple follow-up group of high-risk HPV negative rate were 27.45%（14/51）, negative rate of low-risk HPV were 47.06%（24/51）, cases of progress were all high-risk HPV-positive. In CIN I treatment group and CIN Ⅱ physical therapy the recurrence rate within 1 year were 4.88%（2/41）and 22.2%（2/9）; CIN Ⅱ and CIN Ⅲ cervical cone biopsy or LEEP patients had no recurrence. At present all patients are continued to follow-up. Conclusions： Most CIN I will fade and HPV naturally clear, but HPV-positive patients should be wary of continuing their progress to a high degree of CIN. Follow-up patients who were satisfactory colposcopy, small lesion, voluntary acceptance. CIN Ⅱ and CIN Ⅲ should be used in the treatment of cervical cone biopsy or LEEP, but CIN Ⅲ requires long-term follow. High grade level lesions of the cervix is not recommended to treat by physical therapy.