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背景与目的:宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)是宫颈癌的癌前期病变。近年来,越来越多的年轻女性被诊断出CIN,如何正确而适度的处理CIN是临床处理的目标。本文通过对宫颈上皮内瘤变患者手术治疗前后病理情况分析,探讨治疗宫颈上皮内瘤变的合理方式。方法:对2004年4月至2006年11月间我院收治的315例行宫颈锥切术或子宫切除术的CIN患者进行回顾性分析。比较不同手术治疗前后组织病理诊断,并随访治疗后复发情况。结果:315例患者中,232例(73.65%)行锥切治疗,26例(8.25%)行全子宫切除,57例(18.1%)行次广泛子宫切除。232例锥切治疗患者,术后病理转阴22例,级别升高36例,其中浸润癌20例。锥切术后继续手术治疗15例,其中5例证实有病灶残留。在子宫切除的83例患者中,病理阴性4例,微早浸润癌ⅠA1期3例,浸润癌1B1期4例,该4例接受再次手术或放射治疗。214例锥切为最终治疗,术后未再治疗的CIN患者中,随访中发现5例(2.4%)再次出现宫颈病变。结论:宫颈锥切是一种能准确诊断宫颈病变并能较好治疗CIN的方法。建议对于CIN患者应尽量先行宫颈锥切,根据锥切后病理情况及患者对保留生育功能的要求再决定进一步的处理方案。
BACKGROUND & AIM: Cervical intraepithelial neoplasia (CIN) is a precancerous lesion of cervical cancer. In recent years, more and more young women have been diagnosed with CIN, how to properly and moderately treat CIN is the goal of clinical treatment. This article through the pathological analysis of patients with cervical intraepithelial neoplasia before and after surgery to explore the treatment of cervical intraepithelial neoplasia a reasonable way. Methods: A retrospective analysis was performed on 315 CIN patients who underwent cervical conization or hysterectomy in our hospital from April 2004 to November 2006. Compare the histopathological diagnosis before and after different surgical treatment, and follow-up after treatment recurrence. Results: Among 315 patients, 232 cases (73.65%) underwent conization, 26 cases (8.25%) underwent hysterectomy and 57 cases (18.1%) underwent extensive hysterectomy. 232 cases of conization treatment of patients, postoperative pathology negative in 22 cases, the level increased in 36 cases, of which 20 cases of invasive carcinoma. Conectomy continued surgical treatment of 15 cases, of which 5 cases confirmed residual lesions. Of the 83 patients who underwent hysterectomy, 4 were negative for pathology, 3 for early-invasive carcinoma in stage IA, 4 for invasive carcinoma 1B1 and 4 in re-operation or radiation therapy. 214 cases of conization for the final treatment, no treatment of patients with CIN after follow-up found in 5 cases (2.4%) again cervical lesions. Conclusions: Conization of the cervix is a method that can accurately diagnose cervical lesions and treat CIN well. Recommendations for CIN patients should try first conization of the cervix, according to the post-conization pathology and patient retention of reproductive function requirements and then decide on further treatment options.