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目的根据术后病理分级转化探讨宫颈活检、锥切或全子宫切除术在诊断、治疗宫颈上皮内瘤变的临床意义。方法收集2006年6月～2009年11月在我院CIN活检、电热圈环切术(Leep)或全子宫切除术后病例的相关资料,对患者术前阴道镜定位活检、Leep术或全子宫切除术后病理分级转化和随访资料进行临床分析。结果经阴道镜活检病理证实CIN140例,行宫颈锥切105例,对CINⅢ累及腺体、原位癌等患者35例行子宫全切术。术后病理与术前活检结果相比,锥切术后病理分级转阴41%(43/105),病理分级降级4.76%(5/105),分级一致41%(43/105),分级转高13.3%(14/105);子宫全切术后病理分级显示:转阴、下降均8.6%(3/35),一致62.9%(22/35),转高占20%(7/35)。结论本组活检CIN与Leep后病理分级符合率41%,与全子宫切除术后病理分级符合率为62.9%,术后随访3～36个月无复发情况,表明Leep是诊断、治疗CIN安全且有效的方法,但对于宫颈CINⅢ累及腺体、原位癌等无生育要求、随诊条件差且要求切除子宫的患者选择子宫全切术,可有效降低CIN复发或宫颈浸润癌的发生率。
Objective To investigate the clinical significance of cervical biopsy, conization or total hysterectomy in the diagnosis and treatment of cervical intraepithelial neoplasia according to postoperative pathological grade. Methods The data of CIN biopsy, electroplasty (Leep) or total hysterectomy in our hospital from June 2006 to November 2009 were collected. The patients underwent colposcopy biopsy, Leep surgery or the whole uterus Postoperative pathological grade conversion and follow-up data for clinical analysis. Results colinoscopy biopsy confirmed CIN140 cases, 105 cases of conization of the cervix, CIN Ⅲ involving glands, carcinoma in situ such as 35 cases of hysterectomy. Compared with the preoperative biopsy results, pathological grade was negative (41%, 43/105), pathological grade was 4.76% (5/105), grade was 41% (43/105) (13/35), and 13.3% (14/105) respectively. Pathological grading after hysterectomy showed that the negative rate was 8.6% (3/35), 62.9% (22/35) . Conclusion The biopsy CIN and Leep postoperative pathological grading coincidence rate of 41%, and hysterectomy postoperative pathological grading coincidence rate was 62.9%, followed up for 3 to 36 months without recurrence, indicating that Leep is the diagnosis and treatment of CIN safe Effective method, but for cervical CIN Ⅲ involving gland, carcinoma in situ without fertility requirements, follow-up of poor conditions and require removal of the uterus hysterectomy hysterectomy, CIN can effectively reduce the incidence of recurrence or invasive cervical cancer.