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目的 探讨冰冻病理检查(frozen section examination,FSE)在高级别宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)治疗中的应用价值。方法对200例在郑州大学第一附属医院妇产科阴道镜下活检取材诊断为CINⅡ～Ⅲ的患者行宫颈冷刀锥切术(cold knife conization,CKC)和子宫切除术,并在锥切标本术中行FSE,分析比较FSE结果与所有标本的石蜡病理检查结果(permanent section,PS)及组织切缘病灶残留情况。结果锥切标本冰冻病理检查结果与石蜡病理检查结果相符合率为89.0%(178/200),其中诊断宫颈侵润癌7例,CINⅢ96例,CINⅡ28例,CINⅠ15例,宫颈炎32例。有1例患者,术中FSE诊断为宫颈炎,但术后常规病理结果为宫颈癌Ia1期。所有患者均得到了有效的治疗。FSE与PS比较差异无统计学意义(P>0.05)。FSE在评估切缘时发现:13名患者(6.5%)切缘阳性,行子宫切除术后其宫颈均发现有残留病灶。其余患者切缘为阴性,行子宫切除术后宫颈均未发现残留病灶。结论CKC+FSE是一种快速、准确、有效治疗高级别CIN的方法。术中可有效识别宫颈癌,且可评估锥切组织边缘是否有病灶残留,使手术一步完成。但由于FSE有一定的误诊和漏诊概率,因此仍然需要进一步的研究和观察。
Objective To investigate the clinical value of frozen section examination (FSE) in the treatment of high-grade cervical intraepithelial neoplasia (CIN). Methods 200 cases of CIN Ⅱ ~ Ⅲ patients underwent colposcopy biopsy in obstetrics and gynecology department of the First Affiliated Hospital of Zhengzhou University were treated with cold knife conization (CKC) and hysterectomy. Conical specimens Intraoperative FSE was performed to compare and analyze the FSE results and the paraffin section (PS) of all the specimens and the residual tissue lesions. Results The conformal frozen specimens were 89.0% (178/200) frozen pathological examination and paraffin wax test. Among them, 7 cases were diagnosed as cervical invasive carcinoma, 96 cases were CIN Ⅲ, 28 cases were CIN Ⅱ, 15 cases were CIN Ⅰ and 32 cases were cervicitis. One patient had intraoperative FSE diagnosis of cervicitis, but the routine pathological result was cervical cancer Ia1. All patients received effective treatment. There was no significant difference between FSE and PS (P> 0.05). When assessing the margin, FSE found that 13 patients (6.5%) had positive margins and had residual lesions in their cervix after hysterectomy. The other patients with negative margins, hysterectomy after the cervix did not find any residual lesions. Conclusion CKC + FSE is a rapid, accurate and effective method for the treatment of high-grade CIN. Intraoperative cervical cancer can be effectively identified, and can assess the edge of conical tissue lesions remain, so that the operation was completed in one step. However, due to the misdiagnosis and misdiagnosis probability of FSE, further research and observation are still needed.