论文部分内容阅读
目的分析宫颈原位癌的临床特点及诊治原则。方法对2005年11月至2008年10月在门诊行子宫颈电环切除术(Leep)确诊为宫颈原位癌的35例患者的临床表现、锥切病理、后续处理及预后进行回顾分析。结果 35例患者均接受宫颈涂片和薄层液基细胞学检查及阴道镜下活检病理检查,Leep术后病理均为原位癌。原位癌患者中5例有生育要求且切缘阴性患者Leep术后接受严密随访,1例切缘阳性但有生育要求的患者再次Leep,切缘干净,其余无生育要求的患者29例接受全子宫切除(或加双附件切除)。随访中,1例保留子宫的患者细胞学提示异常,经阴道镜活检诊断为宫颈上皮内瘤变(CINⅢ),并继续要求随访,其余患者未见病变复发。结论阴道镜下活检对诊断宫颈原位癌有重要提示价值,但Leep宫颈锥切术连续切片病理诊断是确诊原位癌的金标准。原位癌锥切后处理主要基于锥切术的病理学结果,同时需要考虑患者的生育要求和切缘状况。
Objective To analyze the clinical features and diagnosis and treatment of cervical carcinoma in situ. Methods The clinical manifestations, conization pathology, follow-up and prognosis of 35 patients with cervical carcinoma in situ diagnosed by cervical ring electrosurgical excision (Leep) from November 2005 to October 2008 were analyzed retrospectively. Results All the 35 patients underwent cervical smear, thin-layer liquid-based cytology and colposcopic biopsy. The pathology of Leep was all in situ carcinoma. In situ cancer patients, 5 cases of reproductive requirements and negative margins patients underwent close follow-up after Leep surgery, 1 case of marginal positive but reproductive requirements of patients again Leep, margin was clean, and the remaining 29 cases of patients without reproductive requirements accepted Hysterectomy (or double attachment removal). During the follow-up, one patient with abnormal uterus showed cytologic abnormalities, and CINⅢ was diagnosed by colposcopy biopsy. Follow-up was required. No recurrence was observed in the rest of the patients. Conclusions Colposcopic biopsy may be valuable in diagnosing cervical carcinoma in situ. However, the pathological diagnosis of cervical intraepithelial neoplasia with Leep cervical conization is the gold standard for the diagnosis of carcinoma in situ. Cone incision in situ cancer is mainly based on the pathological results of conization, and need to consider the patient’s fertility requirements and marginal status.