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[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。
[Objective] To analyze the clinical features and diagnosis and treatment of high-grade cervical intraepithelial neoplasia (CIN) and evaluate the diagnostic value of ultrasonography and intraoperative freezing (FSE). [Methods] The clinical and pathological data of CIN2 / 3 patients who underwent surgery were retrospectively analyzed. The preoperative, intraoperative and postoperative pathological grading and surgical treatment were analyzed. [Results] ① The miscarriage rate (73.91%) and familial malignant tumor family history (32.02%) in patients with CIN2 / 3 were significantly higher than those in controls and positively correlated with the occurrence of CIN. ②58.89% (149/253) cases of CIN2 / 3 color ultrasound showed cervical echocardiography. ③ FSE missed diagnosis of cervical cancer 77.33%, did not improve the diagnosis of high-grade CIN coincidence rate, and PSE consistency is poor (Kappa = 0.217, P <0.001). [Conclusion] The high abortion rate and the family history of malignant tumor may be related to the occurrence of CIN. Color Doppler ultrasound diagnosis of high-level CIN value. FSE has some value in intraoperative decision making, but there is a risk under FSE-guided surgery. Treatment of high-grade CIN should be avoided over / under-treatment.