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目的:测量中重度宫颈上皮内瘤变(CINⅡ/Ⅲ)病灶长度及累及腺体深度,以为要求保留生育功能患者选择恰当的锥切范围提供依据。方法:测量行全子宫切除术患者HE染色切片中宫颈鳞状上皮处CIN病灶长度、正常腺体垂直和水平深度以及CIN病变浸润腺体垂直和水平深度。结果:(1)宫颈鳞状上皮处CIN病灶长度中位数3.80mm,第99百分位数(P99)9.79mm。正常宫颈腺体垂直深度平均18.18mm,99%可信限上限25.40mm;水平深度中位数3.50mm,P999.55mm。CIN病变浸润腺体垂直深度平均9.06mm,99%可信限上限19.50mm;水平深度中位数1.10mm,P99为5.00mm。累及腺体垂直和水平深度百分比平均值分别为51%和35%,最大值均为100%。(2)不同垂直深度CIN累及腺体的水平深度差异无统计学意义(P>0.05)。结论:考虑制片时组织缩水的因素,建议为CIN累腺患者行锥切术的范围应是帽状的:即宫颈阴道部切除范围根据阴道镜检查或碘染色标记决定,宫颈管周围切除范围纵向深度24～30mm,水平深度6～12mm,并根据患者年龄作出选择。
Objective: To measure the length of lesion and the depth of gland involvement in moderate and severe cervical intraepithelial neoplasia (CIN Ⅱ / Ⅲ), so as to provide the basis for choosing proper conization range in patients with reproductive function. Methods: The length of CIN lesions, the vertical and horizontal depths of normal glands and the vertical and horizontal depths of infiltrating glands in CIN lesions were measured in HE-stained sections of hysterectomy patients. Results: (1) The median length of CIN lesions in cervical squamous epithelium was 3.80 mm and the 99th percentile (P99) was 9.79 mm. The normal cervical gland vertical depth average 18.18mm, 99% upper limit of confidence 25.40mm; horizontal depth median 3.50mm, P999.55mm. Vertical depth of infiltration of CIN lesions vertical average 9.06mm, 99% upper limit of confidence 19.50mm; horizontal depth of the median 1.10mm, P99 5.00mm. The mean vertical and horizontal percentages of gland involvement were 51% and 35%, respectively, with a maximum of 100%. (2) There was no significant difference in the depth of CIN involvement between different vertical depths (P> 0.05). CONCLUSIONS: Considering the shrinkage of tissue during tissue preparation, it is recommended that condyctomy should be capped in patients with CIN-impaired glands: the excision range of the cervix vagina is determined by colposcopy or iodine staining, and the extent of resection of the cervix Longitudinal depth of 24 ~ 30mm, horizontal depth of 6 ~ 12mm, and make the choice according to the patient’s age.