| 佟 锐,王纯雁,李联崑.高级别宫颈上皮内瘤变临床特点与诊治分析[J].中国肿瘤,2014,23(5):430-434. |
| 高级别宫颈上皮内瘤变临床特点与诊治分析 |
| Clinical Characteristics，Diagnosis and Treatment of Patients with High-Grade Cervical Intraepithelial Neoplasia |
| 投稿时间：2013-12-07 |
| DOI：10.11735/j.issn.1004-0242.2014.05.A018 |
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| 中文关键词: 高级别宫颈上皮内瘤变 术中冰冻病理检查 冷刀锥切术 彩超 |
| 英文关键词:high-grade cervical intraepithelial neoplasia intraoperative frozen section cold knife conization color Doppler ultrasound |
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| 中文摘要: |
| 摘 要：［目的］分析高级别宫颈上皮内瘤变（CIN）患者的临床及诊治特点，评估彩超、术中冰冻（FSE）的诊断价值。［方法］ 回顾性分析经手术治疗的CIN2/3患者的临床病理资料，分析术前、术中、术后病理分级转化及手术治疗情况。［结果］ ①CIN2/3患者的流产率（73.91%）、恶性肿瘤家族史比例（32.02%）均高于正常对照组，与CIN的发生呈正相关。②58.89%（149/253）的CIN2/3病例彩超表现为宫颈回声异常。③FSE漏诊宫颈癌77.33%，未提高高级别CIN的诊断符合率，与PSE一致性较差（Kappa=0.217，P＜0.001）。［结论］ 高流产率、恶性肿瘤家族史可能与CIN发生有关。彩超对高级别CIN有辅助诊断价值。FSE对术中决策有一定价值，但依据FSE指导手术存在风险。高级别CIN的治疗应避免治疗过度/不足。 |
| 英文摘要: |
| Abstract：［Purpose］ To analyze the clinical characteristics of patients with high-grade cervical intraepithelial neoplasia(CIN)，and to evaluate the diagnostic value of ultrasound and intraoperative frozen(FSE). ［Methods］ The clinicopathological data of CIN2/3 patients after operative treatment were analyzed retrospectively. Preoperative，intraoperative and postoperative pathological grade transformation and surgical treatment were analyzed. ［Results］ ①The abortion rate (73.91%) and family history of cancer incidence(32.02%) in patients with CIN2/3 were higher than those in control group，and positively correlated with CIN. ②Ultrasound showed 58.89%(149/253) patients with abnormal cervical echo.③The missed diagnosis rate of FSE for cervical cancer was 77.33%，and did not improve the diagnostic accuracy of high-grade CIN. The concordance between FSE and PSE was low(kappa=0.217，P＜0.001).［Conclusion］ High abortion rate，family history of cancer might be associated with the occurrence of CIN. The color Doppler ultrasound has assistant diagnostic value to high-grade CIN. FSE has some value for intraoperative strategy，but there is a risk to be used it as an indicator to guide operation. High-grade CIN treatments should avoid over-treatment and inadequate treatment. |
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