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目的总结高级别宫颈上皮内瘤变(CIN)诊治过程中的病理分级变化,探讨宫颈电圈环切术(LEEP)对宫颈病变的诊治价值。方法57例患者行LEEP,病理诊断为CINⅢ、CINⅠ和CINⅠb1,同时接受子宫切除术。分析其细胞学、阴道镜下活检、LEEP宫颈及其全子宫切除的病理结果。结果(1)46例CINⅢ中的8例及9例Ⅰa1中的1例患者最初细胞学结果为非典型鳞状上皮细胞(ASC-US);(2)57例阴道镜下活检病理CIN者,LEEP术后病理符合率54.4%(31/57),CINⅢ、CINI均有术后病理升级;(3)在LEEP诊断的44例CINⅢ中,所切子宫有病灶残留24例,但均未超过LEEP术宫颈病变的病理级别;(4)切缘阳性残留率75.0%(21/28)。结论(1)对ASC-US合理的分流可避免对严重病变的漏诊;(2)阴道镜下活检的病理诊断存在一定的局限性;(3)LEEP作为一种诊断和治疗的有效手段,无论术后切缘状况如何均需严密随诊。
Objective To summarize the pathological grading of high-grade cervical intraepithelial neoplasia (CIN) and evaluate the value of cervical electrosurgery (LEEP) in diagnosis and treatment of cervical lesions. Methods Fifty-seven patients underwent LEEP. The pathological diagnosis was CINⅢ, CINⅠ and CINⅠb1, and hysterectomy was performed. Analysis of their cytology, biopsy colposcopy, LEEP cervix and hysterectomy of the pathological results. Results (1) The initial cytological results were ascitic epithelial cells (ASC-US) in 8 out of 46 CIN Ⅲ cases and in 1 out of 9 Ia1 cases. (2) In 57 colposcopic biopsies with CIN, LEEP postoperative pathological coincidence rate of 54.4% (31/57), CIN Ⅲ, CINI postoperative pathological upgrade; (3) In the 44 cases of LEEP diagnostic CIN Ⅲ, the uterus has lesions in 24 cases, but none of the LEEP The pathological grade of cervical lesions; (4) the positive margin rate of 75.0% (21/28). Conclusions (1) The reasonable diversion of ASC-US can avoid the missed diagnosis of severe pathological changes; (2) The pathological diagnosis of colposcopy biopsy has some limitations; (3) LEEP is an effective means of diagnosis and treatment, The condition of the incision should be closely followed up.